NOTE - in<unk> , do not give aspirin until 24 hours after giving tPA, as ASA with tPA does not improve outcomes and increases bleed risk
Do not give<unk> ly heparin (or any anticoagulation) if giving tPA
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)
10% of dose is administered as bolus; rest is given over 60min
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
Thrombolytics for acute ischemic stroke
Thrombolytics for STEMI
Thrombolytics for pulmonary embolism
Anti-platelet agent reversal
Antiplatelet medications
Dabigatran reversal
Cardiovascular antibiotics
Low molecular weight heparin