AIS No Tpa or Post TPA after 24 hours

Posted On April 25, 2020

Plan

• Get CTA head and neck if not done, Creat has to be normal.
  • If large artery thrombosis, if Last known normal < 24 hours, consider intervention therapy.
• Give Aspirin po 325 mg or 300 mg suppository
  • or other antiplatelet agent
• document reason for no tpa, such as
  • past time window
  • Last known normal not sure
  • INR over 1.4
  • Recent spine/brain surgery

Acute stroke care – general care

• Bed rest, do not walk patient until neuro deficit stabilized.
• Heart monitor, check for atrial fibrillation
  • cardiogenic emboli suspected
• Check glucose stat, if high treat
• Permissive hypertension until neuro status stabilized
  • Small vessel disease, no need for permissive Hypertension
  • tpa not given: keep Systolic BP under 210
    • Embolic stroke: keep BP under 220/110 for 24 hours
  • tpa given: keep systolic BP under 180
  • Intracranial bleed: Keep BP under 140
• Deep vein thrombosis prophylaxis, SCD or sq lovenox 40 mg qd
• Check lipid in am
• Consider High intensity Statin: Atorvastatin (Lipitor) 40-80 mg qd
• Urine drug screen if not done
• Child bearing age female: pregnancy test if indicated
• MRI head to confirm stroke and guide prognosis.
• Speech, Physical therapy eval
• If neuro deficit persisted, rehab eval
• Treat all other risk factors for stroke
• Stroke Education for patient and or family

Additional information:

• Stroke education
  • CDC Preventing stroke
  • CDC Healthy Living
• Statin therapy
• Antiplatelet
• Cardiogenic emboli
• PFO