Post-tPA Hemorrhage in CVA: Difference between revisions

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==Background==
==Background==
#Consider if pt develops:
*Consider post-tPA [[ICH]] if patient develops:
##Decreased LOC
**[[AMS|Decreased LOC]]
##Increased weakness
**Worsening neurologic exam
##New headache
**Increased [[weakness]]
##Sudden rise in BP
**New [[headache]]
**Sudden rise in [[hypertension|BP]]
*May also have [[GI bleed]], mucosal bleeding


==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==
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*[[CVA (Main)]]
*[[CVA (Main)]]


==Source==
==References==
6/06 MISTRY
<references/>
 
[[Category:Neurology]]
[[Category:Neuro]]
[[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