Treatment of AIS: IV Administration of Alteplase

  • Infuse 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the dose given as a bolus over 1 min.
  • 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 alteplase is being administered) and obtain emergency head CT scan.
  • Measure BP and perform neurological assessments every 15 min during and after IV alteplase infusion for 2 h, then every 30 min for 6 h, then hourly until 24 h after IV alteplase treatment.
  • Increase the frequency of BP measurements if SBP is >180 mm Hg or if DBP is >105 mm Hg; administer antihypertensive medications to maintain BP at or below these levels.
  • 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 h after IV alteplase before starting anticoagulants or antiplatelet agents.

Notes

  • AIS = acute ischemic stroke
  • BP = blood pressure
  • CT = computed tomography
  • DBP = diastolic blood pressure
  • IV = intravenous
  • MRI = magnetic resonance imaging
  • SBP = systolic blood pressure.


References

  • 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke, Stroke. 2018 Mar;49(3):e46-e110 doi: 10.1161/STR.0000000000000158