Stop TPA infusion if still running.
Goal: fibrinogen level>100 mg/dL with cryoprecipitate.
. Type and cross.
. Check fibrinogen level immediately and every 6 hours.
. Give 10–20 units of cryoprecipitate before level returns (1 unit raises fibrinogen by 5–10 mg/dL; assume there is no fibrinogen and adjust dose when level is back).
. Repeat cryoprecipitate if needed.
. May use fresh frozen plasma (FFP) in case of no cryoprecipitate (1 unit of cryoprecipitate is made from 1 bag of FFP).
. May give platelet concentrate if low.
. Activated factor 7 is untested in this situation, and should not be used.
. Neurosurgery should be called; however, surgery cannot be done until coagulopathy is corrected and is usually not indicated.
