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CVA ThrombolysisAka: Stroke Thrombolysis, Thrombolysis in Cerebrovascular Accident
- See Also
- Indications (Inclusion Criteria)
- Age over 18 years
- Clinical Diagnosis of acute Ischemic Stroke
- CT Head compatible with Ischemic CVA diagnosis
- Known time of onset under 3 hours before Thrombolytics
- Do not use intravenous tPA beyond 3 hours of symptoms
- Contraindications (Exclusion Criteria)
- Improving or mild neurologic deficit
- Seizure at onset
- Blood sugar abnormality
- Hypoglycemia (<50 mg/dl)
- Hyperglycemia (>400 mg/dl)
- Head Injury or CVA within 90 days
- History of Intracranial Hemorrhage
- Suspected Subarachnoid Hemorrhage (SAH)
- Hypertension refractory to antihypertensives
- Systolic Blood Pressure over 185
- Diastolic Blood Pressure over 110
- Major surgery in last 14 days
- Gastrointestinal hemorrhage in last 21 days
- Genitourinary hemorrhage in last 21 days
- Puncture of inaccessible artery within 7 days
- Coagulation or Platelet abnormalities
- Protocol: Thrombolysis
- t-PA (Alteplase)
- Dose: 0.9 mg/kg (maximum 100 mg)
- Bolus 10% over first minute
- Give Remainder over 1 hour
- Manage Blood Pressure aggressively post-Thrombolytic
- Keep Systolic Blood Pressure under 185
- Keep Diastolic Blood Pressure under 105
- Observed in Intensive Care Unit for first 24 hours
- Keep blood sugar <200 mg/dl
- No other antithrombotic agents given for 24 hours
- CT Head at 72 hours
- t-PA (Alteplase)
- Efficacy
- Prevents 11-13 Deaths and Disability for 100 patients
- References
- Adverse Effects
- Intracranial Hemorrhage
- Hemorrhagic deaths occurred in critically ill
- Very poor prognosis prior to t-PA
- References
- NIH rTPA Trial
- References
- Anderson (1997) Lecture, FP Update, Minneapolis, MN
- Lyden (2001) CMEA Medicine Lecture, San Diego
- Lyden (1998) CMEA Medicine Lecture, San Diego
- Zivin (1999) Neurology 53(1):14
Thrombolysis of intracranial vessel (C0394276) | |
|---|---|
| Concepts | Therapeutic or Preventive Procedure (T061) |
| English | Thrombolysis of intracranial vessel |
| Spanish | trombolisis de vaso intracraneal |
| Parent Concepts | Intracranial vascular operation (C0394240), Destruction of lesion (C0565496) |
| Sources | SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |