Ischemic Stroke: The only blood test that is necessary before tPA usage is
the blood glucose level
. If the patient is on anticoagulation like coumadin, then only we should do PT, PTT, and INR, etc. The benefit of tPA depends a lot on time. The sooner the patient receives tPA; the better are the outcomes.
What are the complications of thrombolytic therapy?
- Hemorrhage.
- Allergic reactions.
- Embolism.
- Stroke.
- Reperfusion arrhythmias.
What are the nursing implications and management of the patient receiving thrombolytic therapy?
- Hemorrhage.
- Allergic reactions.
- Embolism.
- Stroke.
- Reperfusion arrhythmias.
How is thrombolytic therapy administered?
The “clot-busting” drug will be delivered through a
peripheral intravenous (IV) line
, usually through a visible vein in your arm. Performed at your bedside in an intensive care unit while your heart and lung functions are monitored. The drug circulates within the blood stream until it reaches the clot.
What are the contraindications of thrombolytic therapy?
- Recent intracranial hemorrhage (ICH)
- Structural cerebral vascular lesion.
- Intracranial neoplasm.
- Ischemic stroke within three months.
- Possible aortic dissection.
- Active bleeding or bleeding diathesis (excluding menses)
What is the most serious complication of thrombolytic therapy?
Intracranial hemorrhage
, the most devastating complication, occurs in 0.2-1% of patients treated with thrombolytic therapy. Factors associated with incremental risk are now being identified from large clinical trials.
What is the most common complication of fibrinolytic therapy?
The most feared complication of fibrinolysis is
intracranial hemorrhage (ICH)
, but serious hemorrhagic complications can occur from bleeding at any site in the body. Risk factors for hemorrhagic complications include the following: Increasing age. Lower body weight.
What happens if tPA is given too slow?
Bolus to infusion delays
or interruptions in the infusion of TPA after the bolus may significantly impact serum TPA levels and may reduce the efficacy of thrombolysis.
How do you know tPA is working?
To make sure the tPA worked,
a repeat CT scan will be done within a day
or two after the stroke. Endovascular thrombectomy (EVT) is a new breakthrough procedure where doctors insert a thin tube through an artery in the patient’s groin, guiding it with X-ray imaging through blood vessels to the brain.
What happens if tPA is given after 3 hours?
“From analyzing all the available data, tPA [tissue plasminogen activator] after 3 hours for stroke patients
may not be of any benefit but has a definite risk of fatal bleeding
,” Dr Alper told Medscape Medical News.
What is thrombolysis procedure?
Thrombolysis is
a procedure used to break up abnormal blood clots that restrict blood flow in veins and arteries
. We use two types of thrombolysis. For chemical thrombolysis we inject a medication, such as tissue plasminogen activator (tPA) or urokinase, through a catheter to dissolve the clot.
How quickly does thrombolysis work?
Thrombolysis can break down and disperse a clot that is preventing blood from reaching your brain. For most people thrombolysis needs to be given
within four and a half hours of your stroke symptoms
starting. In some circumstances, your doctor may decide that it could still be of benefit within six hours.
What is the golden hour for stroke patients?
A door-to-treatment time
of 60 minutes or less
is the goal. This 60-minute period is often referred to as the “golden hour” of acute ischemic stroke treatment during which a focused diagnostic workup must be completed to rule out conditions that may mimic stroke as well as contraindications to rt-PA administration.
Who is not eligible for thrombolytic therapy?
Thrombolytic therapy cannot be recommended for persons excluded from the NINDS Study
6
for one of the following reasons: (1)
current use of oral anticoagulants or a prothrombin time greater than 15 seconds
(International Normalized Ratio [INR] greater than 1.7); (2) use of heparin in the previous 48 hours and a …
What are the indications for thrombolytic therapy in a stroke?
- Diagnosis of ischemic stroke causing measurable neurologic deficit.
- Neurologic signs not clearing spontaneously.
- Neurologic signs not minor and isolated.
- Symptoms not suggestive of subarachnoid hemorrhage.
- Onset of symptoms less than 3 hours hours before beginning treatment.
What drugs are used in thrombolytic therapy?
- Eminase (anistreplase)
- Retavase (reteplase)
- Streptase (streptokinase, kabikinase)
- t-PA (class of drugs that includes Activase)
- TNKase (tenecteplase)
- Abbokinase, Kinlytic (rokinase)
