Administration of Intravenous Recombinant Tissue Plasminogen Activator (rtPA) for Acute Ischemic Stroke (AIS)a | |
| INDICATION | CONTRAINDICATION |
|---|---|
Clinical diagnosis of stroke Onset of symptoms to time of drug administration ≤4.5 hb CT scan showing no hemorrhage or edema of >1/3 of the MCA territory Age ≥18 years | Sustained BP >185/110 mmHg despite treatment Bleeding diathesis Recent head injury or intracerebral hemorrhage Major surgery in preceding 14 days Gastrointestinal bleeding in preceding 21 days Recent myocardial infarction |
| 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 hc | |
| 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 | |
a See Activase (tissue plasminogen activator) package insert for complete list of contraindications and dosing.
b Depending on the country, IV rtPA may be approved for up to 4.5 h with additional restrictions.
c A dose of 0.6 mg/kg is commonly used in Asia (Japan and China) based on randomized data indicating less hemorrhage and similar efficacy using this lower-dose.
Abbreviations: BP, blood pressure; CT, computed tomography; HCT, hematocrit; INR, international normalized ratio; MCA, middle cerebral artery; PTT, partial thromboplastin time.