ivTPA in acute stroke
3 hr from the onset
contraindications :
Relative contraindications
0.9 mg/kg; max dose = 90mg
10% of the total dose adm as iv bolus over 1 minute
90% of the total dose adm in infusion over 60 min.
Neurochecks q1h
BP < 185/110 mmHg
No anticoag or antiplats for 24 hrs
24 hr post TPA head CT
Pretx
- BP < 185/110; monitor q15min
- If BP > 185/110 , give 1-2 doses of Labetalol 10-20mg iv within 1 hr; if BP is not < 185/110 after labetalol , pt should not receive TPA
During and posttx
First 24 hrs :
Q 15 min x 2 hr
Q 30 min x 6 hrs
Q 1 hr x 18 hrs
- If DBP > 140mmHg – start Nitroprusside (0.5-10micro g / kg/min)
- If SBP > 230 and DBP is 120-140 mmHg – start Labetalol 20mg iv over 1-2 min ; can repeat q10min up to 150 mg; if no good response, use nitroprusside
- If SBP is 180-230 mmHg and DBP is 105-120 mmHg ; use 2 readings 5 min apart; give labetalol 10mg q10min up to max dose 150mg
- Monitor BP q15 min during antiHTN tx