Immediately Stop<unk> , even on suspicion of<unk> -tPA hemorrhage
STAT Head CT
If no bleeding: resume<unk> 
If<unk> -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
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
If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
If INR > 1.4, give additional 20 ml/kg)
If platelets <100,000, give additional PRN to achieve Plt > 100,000
Post-tPA Hemorrhage in CVA
Vertebral and carotid artery dissection
Hypertensive emergency
Ischemic stroke
Hemorrhagic stroke
Subarachnoid hemorrhage
Cerebral edema in brain cancer
Posterior reversible encephalopathy syndrome