Stop alteplase infusion

Call Blood Bank (45114) to request emergency release of 2 pooled units or 10 units (~200 ml) of cryoprecipitate (CRYO)

Maintain SBP < 140 mmHg, DBP < 75 mmHg, and MAP < 95 mmHg

Stat APTT, PT/INR, CBC, and fibrinogen level

• • If INR ≥ 1.4 or greater, consider 3 units of FFP

  • If INR < 1.4, no further action needed

Administer CRYO via blood tubing over 30 minutes

• • If CRYO is contraindicated

    • • Stat tranexamic acid 1000 mg IV x 1, infuse over 10 min

      • Call ED Pharmacist (03482) or Inpatient Pharmacist (00006) to notify Stat order

Repeat fibrinogen level 1 hour after CRYO administration to goal fibrinogen greater than200 mg/dl

• • If fibrinogen ≤ 200 mg/dl

    • • Administer additional 10 units of CRYO

      • Repeat fibrinogen level 1 hour after additional CRYO administration AND every 4 hours for 24 hours

  • If fibrinogen ≥ 200 mg/dl, no further action needed

Stat non-contrast CT Head to rule out bleed