Half life of TPA is ~5 minutes and only 20% is present and active 10 mins after completion of infusion, but PT and PTT prolongation and fibrinogen levels are decreased x 24 hours or more.
- STOP alteplase
- VS q15h, GCS, pupil response, treat BP, increased ICP
- Neurosurgery consult
- DIAGNOSTICS: STAT CT head, PT/PTT, platelets, fibrinogen, type and cross 2-4 unit pRBC
- Transfuse cryoprecipitate 6-8 units IV
- If fibrinogen 50-100mg/dL transfuse 10 bags
- If fibrinogen <50 mg/dL transfuse 20 bags
- Check fibrinogen level 30-60 mins post transfusion, goal fibrinogen level >100 mg/dL
- ALTERNATIVE: transfuse single donor platelets or 6-8 bags of random donor platelets
*each bag of cryoprecipitate contains 200-250 mg of fibrinogen, increases fibrinogen levels by 6-8 mg/dL (in a 70 Kg adult)
*half life of fibrinogen is 3-5 days
Gross, H. and Grose, N. (2017). Emergency Neurological Life Support: Acute Ischemic Stroke. Neurocritical Care, 27(S1), pp.102-115.