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

(Text replacement - "Category:Neuro" to "Category:Neurology")
(Management)
 
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==Background==
 
==Background==
*Consider if pt develops:
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*Consider post-tPA [[ICH]] if patient develops:
**Decreased LOC
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**[[AMS|Decreased LOC]]
**Increased weakness
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**Worsening neurologic exam
**New headache
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**Increased [[weakness]]
**Sudden rise in BP
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**New [[headache]]
 +
**Sudden rise in [[hypertension|BP]]
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*May also have [[GI bleed]], mucosal bleeding
  
 
==Management==
 
==Management==
*Stop tPA
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*Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
*Head CT
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*STAT [[Head CT]]
**If no bleeding: resume tPA
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*If no bleeding: resume tPA
**If bleeding:
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*If post-tPA ICH present
***Consider fibrinogen replacement  
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**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
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**Administer cryoprecipitate 10 units for fibrinogen replacement
***Prepare 6-8 units cryoprecipitate
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***If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
***Prepare 6-8 units platelets
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**Administer FFP 20 ml/kg
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***If INR > 1.4, give additional 20 ml/kg)
 +
**Administer 2-5 packs platelets
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***If platelets <100,000, give additional PRN to achieve Plt > 100,000
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**STAT neurosurgery consult
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**Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures
  
 
==See Also==
 
==See Also==
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==References==
 
==References==
 
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<references/>
 
[[Category:Neurology]]
 
[[Category:Neurology]]
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[[Category:Critical Care]]

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