tPA Question

[punkstar]

What should you watch for, as far as signs and symptoms, when treating an ischemic stroke with tPA (thrombolytic therapy)?

My answer to my own question, if I'm at all correct, is that it is important to watch the patient for signs and symptoms of a hemorrhagic stroke, because I believe a risk factor could be bleeding in the brain or elsewhere (thinking blood thinner...blood thinner).

...now that I brought up Hemorrhagic stroke.

What are signs and symptoms of hemorrhagic stroke?

[Footballnut]

In answer to your original question, watch for any kind of bleeding or any trend indicating that bleeding may be occurring. Hemorrhagic stroke is only one complication. I had one patient start vomiting bright red blood and he had no GI history before the tPA. He made it through just fine, btw.

[mwboswell]

The benchmark standards evaluate the actual incidence of s/p tpa bleeding at 24 hours and 72 hours. National benchmark average is approx 6% complication rate for bleed at 24 hours; a little less at 72 hours. In a facility that is strictly adherent to the Stroke GWTG, the 24 hour bleed rate can drop to 2-3%; which should be reassurring to lots of folks that if you follow the guidelines, screen your pt's appropriately and only give tpa to those who meet strict criteria, then you can avoid/minimize hi-risk bleed complications. Check JAMA 11/2008