How should thrombolytic related symptomatic ICH be managed?
The following recommendations have been proposed for patients experiencing thrombolytic-related Intracerebral Hemorrhage: keep systolic blood pressure <140 mm Hg; check platelet count, fibrinogen, thromboplastin time, and activated partial thromboplastin time; and infuse both platelets (6 to 8 U) and cryoprecipitate, which contains factor VIII to rapidly correct the systemic fibrinoytic state created by tissue plasminogen activator.
If fibrinogen is <100 mg/dL administer cryoprecipitate 0.10 μ/kg IV. Repeat fibrinogen in 1 hour, and if it is <100 mg/dL, repeat cryoprecipitate dose IV and consult neurosurgery.
