Step 8: ACLS Stroke Protocol
At this point a brief discussion of fibrinolytic therapy is in order. The primary medication used for fibrinolytic therapy is rtPA (recombinant tissue plasminogen activator). rtPA is a protein that is used to break apart blood clots that have formed in the vascular system. Recombinant tissue plasminogen activators (rtPAs) include alteplase, reteplase, and tenecteplase (TNKase). rtPA is given IV 0.9 mg/kg with a maximum of 90 mg and is infused over 60 minutes with 10% of the total dose administered as an initial intravenous bolus over 1 minute.
Once fibrinolytic therapy has been started, the patient should not receive any other type of anticoagulant therapy for 24 hours. Ideally, the patient should receive a repeat head CT scan after 24 hours to ensure the patient has no intracranial bleeding.