Acute Stroke 2 – consider TPA

Posted On February 16, 2020

Goal: Door to needle under 45 minutes (Time from arrival to TPA given)

Tests:

• Absolutely needed
  • CT head wo contrast to rule out bleed
  • glucose > 50
• Get the following but do not delay tpa
• O2 sat- BMP, CBC, INR, PTT
• troponin, ECG

Consider TPA if:

• Significant neuro deficits: such as hemiparesis, speech problem, visual field loss, ataxia
• History strongly suggestive of stroke, less likely to be other neuro problem

No tpa if any of the following

• Recent use of noac within 48 hours
• Coagulopathy (platelete < 100k, inr > 1.7, aPTT> 40, or PT >15)
• Infective endocarditis
• Intracranial, spine surgery < 3 months
• Recent GI/GU bleed within 3 weeks
• Extensive hypoattenuation on CT
• Suspicion for Subarachnoid Hemorrhage
• Suspicion for aortic dissection
• Hx of sickle cell disease

TPA may still be possible, assess risks vs benefit

• severe symptoms (Benefit outweigh risks, do have higher risk for bleed, need to explain to family)
• mild but disabling symptom
• stroke with acute MI
• unruptured cerebral aneurysm > 10 mm

CT head show bleed