What are the BP target recommendations for patients enrolled in 6-hour RCTs receiving IV alteplase?
The trial protocols stipulated management according to local guidelines with BP 180/105 during and for 24 hours after the procedure for these participants. Two trial protocols provided additional recommendations. The ESCAPE protocol states that SBP 150 mmHg is probably useful in promoting and keeping collateral flow adequate while the artery remains occluded and that controlling BP once reperfusion has been achieved and aiming for a normal BP for that individual is sensible. Labetalol or an IV -blocker such as metoprolol in low doses is recommended.105 The DAWN protocol recommends maintaining SBP <140 mmHg in the first 24 hours in subjects who are reperfused after mechanical thrombectomy (defined as achieving more than two-thirds MCA territory reperfusion).51 Further studies are needed to determine the optimal BP target during and after mechanical thrombectomy.