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.
If the patient develops severe headache, acute hypertension, nausea, or vomiting or has a worsening neurological examination, discontinue the infusion (if IV rtPA is being administered) and obtain emergent CT scan.
Measure blood pressure and perform neurological assessments every 15 minutes during and after IV rtPA infusion for 2 hours, then every 30 minutes for 6 hours, then hourly until 24 hours after IV rtPA treatment.
Increase the frequency of blood pressure measurements if systolic blood pressure is >180 mmHg or if diastolic blood pressure is >105 mmHg; administer antihypertensive medications to maintain blood pressure at or below these levels (Table 8).
Delay placement of nasogastric tubes, indwelling bladder catheters, or intra-arterial pressure catheters if the patient can be safely managed without them.
Obtain a follow-up CT or MRI scan at 24 hours after IV rtPA before starting anticoagulants or antiplatelet agents.
  • CT indicates computed tomography; IV, intravenous; MRI, magnetic resonance imaging; and rtPA, recombinant tissue plasminogen activator.