Dose and Administration

The dosage for t-PA is 0.9 mg/kg, with a maximum dose of 90 mg. Ten percent of the calculated dose is
administered as an IV bolus over 1 minute. The remaining dose (90%) is administered IV over 1 hour via
an infusion pump.

Summary of National Institutes of Health Stroke Scale

Side effects

Bleeding is the most common side effects of t-PA administration, and the patient is closely monitored
for any bleeding (IV insertion sites, urinary catheter site, nasogastric tube, urine, and stool)

Intracranial bleeding is a major complication that occurred in approximately 6.4% of patients in the
initial t-PA study. A number of factors are associated with the occurrence of symptomatic intracranial
bleeding: age greater than 70 years, baseline NIHSS score greater than 20, serum glucose concentration
300 mg/dl or higher, and edema or mass effect observed on the patient’s initial CT scan.

Therapy for Patients with Ischemic Stroke not receiving Tissue Plasminogen Activator

Interventions during this period include measures to reduce ICP, such as administration an osmotic
diuretic (mannitol), and maintaining the partial pressure of arterial carbon dioxide (PaCO2), within a
slightly lower range of 30 to 35 mg Hg. Other treatment measures include the following:

 Providing supplemental oxygen

 Elevation of the head of the bed to 25-30 degrees
 Possible hemicraniectomy for increased ICP
 Incubation with an endotracheal tube
 Continous hemodynamic monitoring
 Frequent neurologic assessments

Managing Potential Compliation

If cerebral blood flow is inadequate, the amount of oxygen supplied to the brain will decrease, and
tissue ischema will result.

Other potential complication after a stroke include urinary tract infections, cardiac dysrhythmias
(ventricular ectopy, tachycardia, and heart blocks) and complications of immobility.