Ver el código de «Post-tPA Hemorrhage in CVA»

==Background==
*Consider post-tPA [[ICH]] if patient develops:
**[[AMS|Decreased LOC]]
**Worsening neurologic exam
**Increased [[weakness]]
**New [[headache]]
**Sudden rise in [[hypertension|BP]]
*May also have [[GI bleed]], mucosal bleeding

==Management==
*Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
*STAT [[Head CT]]
*If no bleeding: resume tPA
*If post-tPA ICH present
**Obtain baseline labs: CBC, D-dimer, type and screen, fibrinogen. Check INR 15 minutes after FFP administration (see below) and platelets 15 min after platelet administration (see below)
**Administer cryoprecipitate 10 units for fibrinogen replacement
***If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
**Administer FFP 20 ml/kg 
***If INR > 1.4, give additional 20 ml/kg)
**Administer 2-5 packs platelets 
***If platelets <100,000, give additional PRN to achieve Plt > 100,000
**STAT neurosurgery consult
**Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures

==See Also==
*[[CVA (tPA Criteria)]]
*[[CVA (Main)]]

==References==
<references/>
[[Category:Neurology]]
[[Category:Critical Care]]