vi medicine informatics




Patients with the clinical diagnosis of ischemic stroke who are ≥ 18 years old, with symptom onset < 4.5 hours (or < 4.5 hours from last time patient was seen asymptomatic) are treated with recombinant tissue plasminogen activator (tPA), such as alteplase. The current guidelines for tPA therapy are shown. A systolic blood pressure >185/90 mmHg is a contraindication for tPA therapy. Patients with a systolic blood pressure >185 mmHg or a diastolic blood pressure of >110 mmHg should be treated with antihypertensives such as intravenous labetalol or nicardipine prior to starting thrombolytic therapy. If intravenous treatment does not bring the blood pressure into the acceptable range, the patient should not be treated with tPA because the risk of intracerebral hemorrhage may be increased.

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