Template:TPA Stroke - Revision history

Kxl328: /* Alteplase */

2019-04-21T17:09:11Z

Alteplase

← Older revision		Revision as of 17:09, 21 April 2019
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	===[[Alteplase]]===		===[[Alteplase]]===
	*NOTE - in stroke, do not give [[aspirin]] until 24 hours after giving tPA, as it does not improve outcomes and increases bleed risk<ref>Zinkstok SM, Roos YB, ARTIS Investigators . Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet (2012) 380(9843):731–7.10.1016/S0140-6736(12)60949-0.</ref>		*NOTE - in stroke, do not give [[aspirin]] until 24 hours after giving tPA, as ASA with tPA does not improve outcomes and increases bleed risk<ref>Zinkstok SM, Roos YB, ARTIS Investigators . Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet (2012) 380(9843):731–7.10.1016/S0140-6736(12)60949-0.</ref>
	*Do not give acutely heparin (or any anticoagulation) if giving tPA<ref>Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review. Rob A. van de Graaf, Vicky Chalos, Gregory J. del Zoppo, Aad van der Lugt, Diederik W. J. Dippel, Bob Roozenbeek. Front Neurol. 2018; 9: 238.</ref>		*Do not give acutely heparin (or any anticoagulation) if giving tPA<ref>Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review. Rob A. van de Graaf, Vicky Chalos, Gregory J. del Zoppo, Aad van der Lugt, Diederik W. J. Dippel, Bob Roozenbeek. Front Neurol. 2018; 9: 238.</ref>
	Dosing:		Dosing:

Kxl328: /* Alteplase */

2019-04-21T17:08:37Z

Alteplase

← Older revision		Revision as of 17:08, 21 April 2019
Line 1:		Line 1:
	===[[Alteplase]]===		===[[Alteplase]]===
			*NOTE - in stroke, do not give [[aspirin]] until 24 hours after giving tPA, as it does not improve outcomes and increases bleed risk<ref>Zinkstok SM, Roos YB, ARTIS Investigators . Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet (2012) 380(9843):731–7.10.1016/S0140-6736(12)60949-0.</ref>
			*Do not give acutely heparin (or any anticoagulation) if giving tPA<ref>Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review. Rob A. van de Graaf, Vicky Chalos, Gregory J. del Zoppo, Aad van der Lugt, Diederik W. J. Dippel, Bob Roozenbeek. Front Neurol. 2018; 9: 238.</ref>
	Dosing:		Dosing:
	*0.9mg/kg IV (max 90mg total)		*0.9mg/kg IV (max 90mg total)

Rossdonaldson1: /* Alteplase */

2019-03-05T06:16:53Z

Alteplase

← Older revision		Revision as of 06:16, 5 March 2019
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	===Alteplase===		===[[Alteplase]]===
	Dosing:		Dosing:
	*0.9mg/kg IV (max 90mg total)		*0.9mg/kg IV (max 90mg total)

Ostermayer at 02:53, 29 September 2015

2015-09-29T02:53:05Z

← Older revision		Revision as of 02:53, 29 September 2015
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	#Alteplase 0.9mg/kg IV (max 90mg total)		===Alteplase===
	#*10% of dose is administered as bolus; rest is given over 60min		Dosing:
	~~#Neuo~~ check Q15min x 2hr		*0.9mg/kg IV (max 90mg total)
	#No anticoagulation/antiplatelets x 24hr		**10% of dose is administered as bolus; rest is given over 60min
	#Blood pressure (keep SBP <180, DBP <105)		*Neuro check Q15min x 2hr
	#*If SBP is 180-230 or DBP is ~~105-~~120:		*No anticoagulation/antiplatelets x 24hr
	#**[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR		*Blood pressure (keep SBP <180, DBP <105)
	#**[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min		If SBP is >180-230 or DBP is >120:
	~~#*If SBP is >230 or DBP 121-140:~~		*[[Nicardipine]] 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR
	~~#**[[Labetalol]] as above OR [[nicardipine]] 5mg/hr; titrate up by 2.5 mg/hr at 5-15min intervals; max dose 15mg/hr~~		*[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
	#*If BP not controlled by above measures:		*[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min
	#**[[Nitroprusside]] 0.5–10mcg/kg/min		If BP not controlled by above measures:
	#***Continuous arterial monitoring advised		*[[Nitroprusside]] 0.5–10mcg/kg/min
	#***Use with caution in patients with hepatic or renal insufficiency		*Continuous arterial monitoring advised
			*Use with caution in patients with hepatic or renal insufficiency

Ostermayer: Created page with "#Alteplase 0.9mg/kg IV (max 90mg total) #*10% of dose is administered as bolus; rest is given over 60min #Neuo check Q15min x 2hr #No anticoagulation/antiplatelets x 24hr #Bl..."

2015-09-29T02:49:19Z

Created page with "#Alteplase 0.9mg/kg IV (max 90mg total) #*10% of dose is administered as bolus; rest is given over 60min #Neuo check Q15min x 2hr #No anticoagulation/antiplatelets x 24hr #Bl..."

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#Alteplase 0.9mg/kg IV (max 90mg total)
#*10% of dose is administered as bolus; rest is given over 60min
#Neuo check Q15min x 2hr
#No anticoagulation/antiplatelets x 24hr
#Blood pressure (keep SBP <180, DBP <105)
#*If SBP is 180-230 or DBP is 105-120:
#**[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
#**[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min
#*If SBP is >230 or DBP 121-140:
#**[[Labetalol]] as above OR [[nicardipine]] 5mg/hr; titrate up by 2.5 mg/hr at 5-15min intervals; max dose 15mg/hr
#*If BP not controlled by above measures:
#**[[Nitroprusside]] 0.5–10mcg/kg/min
#***Continuous arterial monitoring advised
#***Use with caution in patients with hepatic or renal insufficiency