Template:TPA Stroke

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  1. Alteplase 0.9mg/kg IV (max 90mg total)
    • 10% of dose is administered as bolus; rest is given over 60min
  2. Neuo check Q15min x 2hr
  3. No anticoagulation/antiplatelets x 24hr
  4. Blood pressure (keep SBP <180, DBP <105)
    • If SBP is 180-230 or DBP is 105-120:
      • Labetalol 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
      • Labetalol 10mg IV followed by infusion at 2–8 mg/min
    • If SBP is >230 or DBP 121-140:
      • Labetalol as above OR nicardipine 5mg/hr; titrate up by 2.5 mg/hr at 5-15min intervals; max dose 15mg/hr
    • If BP not controlled by above measures:
      • Nitroprusside 0.5–10mcg/kg/min
        • Continuous arterial monitoring advised
        • Use with caution in patients with hepatic or renal insufficiency