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

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Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure
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==Background==
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*Consider post-tPA [[ICH]] if patient develops:
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**[[AMS|Decreased LOC]]
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**Worsening neurologic exam
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**Increased [[weakness]]
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**New [[headache]]
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**Sudden rise in [[hypertension|BP]]
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*May also have [[GI bleed]], mucosal bleeding
  
 
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==Management==
If bleeding occurs after tPA:
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*Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
# Stop tpa infusion
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*STAT [[Head CT]]
# Stat head CT
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*If no bleeding: resume tPA
## if no bleeding resume tpa
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*If post-tPA ICH present
## If bleeding check labs, 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 pt/ptt, platelets, 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)
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**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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*[[CVA (Main)]]
 
*[[CVA (Main)]]
  
==Source==
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==References==
6/06 MISTRY
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<references/>
 
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[[Category:Neurology]]
[[Category:Heme/Onc]]
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[[Category:Critical Care]]
[[Category:Neuro]]
 

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