What is Emergency Medicine -How should I handle ICH in the presence of tPA ?
Within 24 hours of taking tPA, the patient should be evaluated for ICH if they experience a sudden neurologic decline, a new headache, nausea, or vomiting. The tPA should be stopped right away, a non-contrast head CT should be done, and blood samples should be sent for laboratory analysis (i.e., type and crossmatch, PT, PTT, platelets, fibrinogen). The treatment of ICH following the administration of tPA has not been the subject of prospective data collection; however, expert opinions are provided in guidelines that advise 10 units of cryoprecipitate, 6-8 units of platelets (or one single donor unit), and neurosurgical consultation for potential hematoma evacuation. Other reversal agents are an option, however they are debatable. Examples include FFP, PCC, and TXA.
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