What management strategies should be employed for symptomatic intracranial bleeding occurring within 24 hours after administration of IV Alteplase for treatment of AIS?
Management strategies for symptomatic intracranial bleeding occurring within 24 hours after administration of IV Alteplase for treatment of AIS include stopping the alteplase infusion, conducting a CBC, PT (INR), aPTT, fibrinogen level, and type and cross-match, obtaining an emergent non-enhanced head CT, administering cryoprecipitate (includes factor VIII): 10 U infused over 10-30 minutes (onset in 1 hour, peaks in 12 hours); administering additional dose for fibrinogen level of <150 mg/dL, administering tranexamic acid 1000 mg IV infused over 10 minutes or -aminocaproic acid 4-5 g over 1 hour, followed by 1 g IV until bleeding is controlled (peak onset in 3 hours), consulting a hematology and neurosurgery specialist, and providing supportive therapy, including BP management, ICP, CPP, MAP, temperature, and glucose control. 