Post-tPA Hemorrhage in CVA

(Redirected from CVA (Post-tPA Hemorrhage))

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

Authors:

Ross Donaldson