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Template:TPA Stroke
From WikEM
Alteplase
Dosing:
- 0.9mg/kg IV (max 90mg total)
- 10% of dose is administered as bolus; rest is given over 60min
- Neuro check Q15min x 2hr
- No anticoagulation/antiplatelets x 24hr
- Blood pressure (keep SBP <180, DBP <105)
If SBP is >180-230 or DBP is >120:
- 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 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 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
