Table 9. Additional Inclusion and Exclusion Characteristics
of Patients With Acute Ischemic Stroke Who Could
Be Treated With IV rtPA Within 3-4.5 Hours From
Symptom Onset
Inclusion criteria
Diagnosis of ischemic stroke causing measurable neurological deficit
Onset of symptoms within 3-4.5 hours before beginning treatment
Relative exclusion criteria
Aged >80 years
Severe stroke (NIHSS score >25)
Taking an oral anticoagulant regardless of INR
History of both diabetes and prior ischemic stroke
Table 10. Treatment of Acute Ischemic Stroke:
IV Administration of rtPA
• 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 BP and perform neurological assessments q 15 min during and after
IV rtPA infusion for 2 hours, then q 30 min for 6 hours, then qh until 24 hours
after IV rtPA treatment.
• Increase the frequency of BP measurements if systolic BP is >180 mm Hg or
if diastolic BP is >105 mm Hg. Administer antihypertensive medications to
maintain blood pressure at or below these levels.
• Delay placement of nasogastric tubes, indwelling bladder catheters, or intraarterial 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.
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