Categories: Neurology

When to administer Tissue Plasminogen Activator (tPA)

tPA is considered a gold standard for treatment of patients with ischemic strokes.

Mechanism: Works by dissolving clots and restoring/improving blood perfusion to part of the brain that was previously impeded.

Important: Differentiate ischemic and hemorrhagic stroke by administering CT scan. tPA will not be useful in hemorrhagic strokes as decreased perfusion to brain is result of intracranial bleeding as opposed to a vascular obstruction.

When to give: Must be given within 3-4.5 hours from onset of stroke symptoms. *NOTE: it is from the time the patient was last asymptomatic, hence if a patient awakes with stroke symptoms, they were last asymptomatic whatever time they fell asleep.

How is it administered: IV

REFERENCES

1. Davis SM, Donnan GA (June 2009). “4.5 hours: the new time window for tissue plasminogen activator in stroke”. Stroke 40 (6): 2266–7. 

2. Fonarow GC, Zhao X, Smith EE, et al. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203. 

Get Medical Pearls directly to your inbox every week!
Weekly posts with high yield medical knowledge, directly to your mailbox!
Dr. C Humphreys

Internal Medicine

Recent Posts

Older Age and Obstructive Sleep Apnea (OSA): Mechanism

Older age is recognized as a risk factor for obstructive sleep apnea.[1] But why? Suspected…

2 months ago

How does Weight Affect Obstructive Sleep Apnea (OSA): Mechanism

Being overweight (BMI ≥ 25 kg/m2)/Obese (BMI ≥ 30 kg/m2) is one of the most…

2 months ago

Nocturia and OSA: Mechanism

Nocturia is a common symptom associated with obstructive sleep apnea. [1] Img Cred: Am J…

1 year ago

ASD vs. VSD Murmur Difference

ASD (Atrial Septal Defect) Wide, Fixed split S2 (in contrast to the normal variation in…

1 year ago

Mechanism of a Mixed Apnea

Mixed apneas are characterized by absent respiratory effort and airflow in the first section of…

2 years ago

How Does Hypothyroidism Cause Hypoventilation?

Although rare, the differential diagnosis of hypoventilation and hypercapnia respiratory failure includes hypothyroidism. It is…

2 years ago

This website uses cookies.