Administration of Intravenous rtPA for AISa
| Indication | Contraindication |
|---|---|
Clinical diagnosis of stroke | Sustained bp >185/110 mmHg despite treatment |
Onset of symptoms to time of drug administration ≤4.5 hb | Platelets <100,000; Hct<25%; glucose <50 or >400 mg/dL |
CT scan showing no hemorrhage or edema of >1/3 of the MCA territory | Use of heparin within 48 h and prolonged PTT, or elevated INR |
Age 18 ≥ years | Rapidly improving symptoms |
Consent by patient or surrogate | Prior stroke or head injury within 3 months; prior intracranial hemorrhage |
| Major surgery in preceding 14 days | |
| Minor stroke symptoms | |
| Gastrointestinal bleeding in preceding 21 days | |
| Recent myocardial infarction | |
| Coma or stupor | |
| Administration of rtPA | |
| IV access with two peripheral IV lines (avoid arterial or central line placement). | |
| Review eligibility for rtPA. | |
| Administer 0.9 mg/kg IV (maximum 90 mg) IV as 10% of total dose by bolus, followed by remainder of total dose over 1 h. | |
| Frequent cuff blood pressure monitoring. | |
| No other antithrombotic treatment for 24 h. | |
| For decline in neurologic status or uncontrolled blood pressure, stop infusion, give cryoprecipitate, and reimage brain emergently. | |
| Avoid urethral catheterization for ≥2 h. | |
aSee Activase (tissue plasminogen activator) package insert for complete list of contraindications and dosing.
bDepending on the country, IV rtPA may be approved for up to 4.5 h with additional restrictions.
Abbreviations: AIS, acute ischemic stroke; INR, international normalized ratio; MCA, middle cerebral artery; rtPA, recombinant tissue plasminogen activator; PTT, partial thromboplastin time.