tPA Reversal

• Stop tPA infusion

• STAT neurosurgery consult

• STAT CBC, INR, PT, PTT, platelets, fibrinogen, D-dimer, type and screen

  • Fibrinogen < 100 mg/dL

    • Give cryoprecipitate 0.15 units/kg

    • If still bleeding at 1 hr and fibrinogen still < 100 mg/dL, repeat cryoprecipitate .15 units/kg dose

  • Alternatives to cryoprecipitate

    • Tranexamic acid 1000 mg IV infused over 10 minutes

    • Aminocaproic acid 4-5 g infused over 1 hour followed by 1g IV until bleeding is controlled