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Table 65.7

Thrombolysis with Alteplase for Ischaemic Stroke

  • Explain risks and benefits (2–5% symptomatic haemorrhage rate; it will not affect mortality rate overall, improved chance of surviving with less disability. NNT of 7 treating within 3h of symptom onset and NNT of 14 when treating within 4.5h).
  • Give alteplase 0.9 mg/kg to a maximum of 90 mg with 10% of the bolus over 2 min intravenously and the remainder by an infusion over 60 min.
  • Check neurological signs and general observations:
    • Every 15 min for 2h
    • Every 30 min for 6h
    • Every 60 min for 16h
  • Repeat brain imaging after 24h.
  • Keep blood pressure at or below 180/105 mmHg for first 24h.
  • Do not give aspirin until 24h after thrombolysis.