15. TPA - Relative contraindications
Seizure at the onset of stroke – Patients with seizures was excluded from the initial studies of TPA because they made it difficult to assess how much of the neurologic deficit was due to the seizure and how much due to the stroke.
16. Blood pressure control is very important to prevent complications
FOR DOCTORS ONLY!
Before treatment, the goal is <185/<110mm Hg. Labetalol (Trandate, Normodyne) 10–20mg IV or a nicardipine (Cardene) drip (start at 5 mg/h and titrate up to a maximum of 15 mg/h) may be given to lower the blood pressure.
17. TPA Procedure
Remember: time is brain. Best results occur with treatment started within 2 hours of symptom onset.
18. TPA Dose
- TPA 0.9 mg/kg up to a maximum of 90mg total.
- 10% given as IV bolus over 1 minute.
- Remaining 90% infused over 1 hour.
19. TPA-Related Intracranial Hemorrhage: Management Protocol
Stop TPA infusion if still running.
Goal: fibrinogen level>100 mg/dL with cryoprecipitate.
- 20. Oropharyngeal Angioedema: Management Protocol
- 21. What are the risks of TPA therapy?
- 22. What are the benefits of TPA therapy?
- 23. Who benefits?
- 24. Who is more likely to bleed?
- 25. Intravenouslytics or Intra-Arterial therapy beyond 3 hours
- 26. Who should be considered for IA therapy?
- 27.Neurological deterioration in acute ischemic stroke
- 28.Cerebral edema and mass effect
- 29. Metabolic disturbance