Difference between revisions of "Post-tPA Hemorrhage in CVA"

(Background)
(Management)
 
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==Management==
 
==Management==
*Stop tPA
+
*Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
*[[Head CT]]
+
*STAT [[Head CT]]
**If no bleeding: resume tPA
+
*If no bleeding: resume tPA
**If bleeding:
+
*If post-tPA ICH present
***Consider fibrinogen replacement  
+
**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)
***Recheck CBC, coags fibrinogen levels
+
**Administer cryoprecipitate 10 units for fibrinogen replacement
***Prepare 6-8 units [[cryoprecipitate]]
+
***If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
***Prepare 6-8 units [[platelets]]
+
**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==

Latest revision as of 20:42, 27 November 2019

Background

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

References