February 7, 2011 by dailybolusoflr
Patients with signs and symptoms of ischemic stroke who present within the 3 hour window and meet all criteria for intravenous tPA can be considered candidates. This is a Class 1 Level A recommendation.
The dose of alteplase for acute ischemic stroke is 0.9 mg/kg (max dose is 90mg)
-10% is administered as a bolus over 1 minute
-the remaining 90% infused over the remaining 60 minutes
Intra-arterial thrombolysis is an option for treatment of selected patients who have major stroke of <6 hours duration due to occlusions of the MCA and who are not otherwise candidates for intravenous rtPA. This is a Class 1 Level B recommendation.
For a full review of the indications, contra-indications, please review the attached article.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions