Acute Ischemic Stroke Management: TPA Dosing, Post-TPA Care, and Thrombolysis Eligibility

This session covers the fundamentals of acute ischemic stroke management, including the standard dosing protocol for tissue plasminogen activator (TPA), post-TPA monitoring requirements, eligibility criteria for intravenous thrombolysis, key contraindications including bleeding diathesis, and the role of blood pressure control in the acute setting.

Practitioner-Guided Note

Ensure blood pressure is below 185/110 before and during TPA administration. Platelet count must exceed 100,000/uL; INR must be below 1.7 and PT below 15 seconds if on warfarin. Repeat CT at 24 hours post-TPA is mandatory. Hold all antiplatelet agents for 24 hours after thrombolysis.

Key Takeaways

TPA dose: 0.9 mg/kg (max 90 mg); 10% bolus, 90% infused over 1 hour.Post-TPA care requires 24-hour ICU monitoring with BP kept below 185/110.Eligibility requires age 18+, confirmed ischemic stroke with neurological deficit, and symptom onset within 3 hours (up to 4.5 hours in select cases).Absolute contraindications include prior intracranial hemorrhage, AVM or aneurysm, BP over 185/110, recent intracranial surgery or head trauma, active bleeding, and hemorrhage on CT.Bleeding diathesis contraindications: platelets below 100,000/uL, heparin use within 48 hours with elevated aPTT, or warfarin use with PT over 15 seconds or INR above 1.7.