|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.