TABLE 12. Treatment of Acute Ischemic Stroke: Intravenous Administration of rtPA

Infuse 0.9 mg/kg (maximum dose 90 mg) over 60 minutes with 10% of the dose given as a bolus over 1 minute.
Admit the patient to an intensive care or stroke unit for monitoring.
Perform neurological assessments every 15 minutes during the infusion and every 30 minutes thereafter for the next 6 hours, then hourly until 24 hours after treatment.
If the patient develops severe headache, acute hypertension, nausea, or vomiting, discontinue the infusion (if rtPA is being administered) and obtain emergency CT scan.
Measure blood pressure every 15 minutes for the first 2 hours and subsequently every 30 minutes for the next 6 hours, then hourly until 24 hours after treatment.
Increase the frequency of blood pressure measurements if a systolic blood pressure is ≥180 mm Hg or if a diastolic blood pressure is ≥105 mm Hg; administer antihypertensive medications to maintain blood pressure at or below these levels (see Table 10).
Delay placement of nasogastric tubes, indwelling bladder catheters, or intra-arterial pressure catheters.
Obtain a follow-up CT scan at 24 h before starting anticoagulants or antiplatelet agents.