Difference between revisions of "Post-tPA Hemorrhage in CVA"
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==Background== | ==Background== | ||
| − | + | *Consider post-tPA [[ICH]] if patient develops: | |
| − | + | **[[AMS|Decreased LOC]] | |
| − | + | **Worsening neurologic exam | |
| − | + | **Increased [[weakness]] | |
| − | + | **New [[headache]] | |
| + | **Sudden rise in [[hypertension|BP]] | ||
| + | *May also have [[GI bleed]], mucosal bleeding | ||
==Management== | ==Management== | ||
| − | + | *Immediately Stop tPA, even on suspicion of post-tPA hemorrhage | |
| − | + | *STAT [[Head CT]] | |
| − | + | *If no bleeding: resume tPA | |
| − | + | *If post-tPA ICH present | |
| − | + | **Obtain baseline labs: CBC, D-dimer, type and screen, fibrinogen. Check INR 15 minutes after FFP administration (see below) and platelets 15 min after platelet administration (see below) | |
| − | + | **Administer cryoprecipitate 10 units for fibrinogen replacement | |
| − | + | ***If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units | |
| − | + | **Administer FFP 20 ml/kg | |
| + | ***If INR > 1.4, give additional 20 ml/kg) | ||
| + | **Administer 2-5 packs platelets | ||
| + | ***If platelets <100,000, give additional PRN to achieve Plt > 100,000 | ||
| + | **STAT neurosurgery consult | ||
| + | **Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures | ||
==See Also== | ==See Also== | ||
| Line 20: | Line 27: | ||
*[[CVA (Main)]] | *[[CVA (Main)]] | ||
| − | == | + | ==References== |
| − | + | <references/> | |
| − | + | [[Category:Neurology]] | |
| − | [[Category: | + | [[Category:Critical Care]] |
Latest revision as of 20:42, 27 November 2019
Contents
Background
- Consider post-tPA ICH if patient develops:
- Decreased LOC
- Worsening neurologic exam
- Increased weakness
- New headache
- Sudden rise in BP
- May also have GI bleed, mucosal bleeding
Management
- Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
- STAT Head CT
- If no bleeding: resume tPA
- If post-tPA ICH present
- Obtain baseline labs: CBC, D-dimer, type and screen, fibrinogen. Check INR 15 minutes after FFP administration (see below) and platelets 15 min after platelet administration (see below)
- Administer cryoprecipitate 10 units for fibrinogen replacement
- If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
- Administer FFP 20 ml/kg
- If INR > 1.4, give additional 20 ml/kg)
- Administer 2-5 packs platelets
- If platelets <100,000, give additional PRN to achieve Plt > 100,000
- STAT neurosurgery consult
- Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures