4077F Documentation that tissue plasminogen activator (t-PA) administration was considered (STR)

Name of the Procedure:

Tissue Plasminogen Activator (t-PA) Administration
Alternate Names: Alteplase, rtPA, Thrombolytic Therapy

Summary

Tissue plasminogen activator (t-PA) administration is a procedure where a medication is used to dissolve blood clots. This treatment is often utilized in the case of acute ischemic strokes to restore blood flow to the brain.

Purpose

This procedure is specifically aimed at treating acute ischemic stroke, which occurs when a blood clot blocks a blood vessel in the brain. The primary goal is to dissolve the clot quickly to minimize damage to brain tissue and improve the chances of recovery.

Indications

• Symptoms of an acute ischemic stroke, such as sudden weakness or numbness, trouble speaking, or loss of vision.
• Diagnosis confirmed by imaging studies like a CT scan.
• Time of symptom onset is clearly known and falls within the therapeutic window, typically within 4.5 hours.

Preparation

• Initial assessment in Emergency Department or Stroke Unit.
• Detailed medical history and physical examination.
• Non-contrast CT scan of the head to exclude hemorrhage.
• Blood tests, including coagulation profile.
• Keeping the patient and family informed about the procedure, benefits, and risks.

Procedure Description

1. An intravenous (IV) line is established.
2. The patient is continuously monitored for vital signs and neurological status.
3. t-PA is administered through the IV line usually over a period of 60 minutes, based on a precise dosing algorithm.
4. Frequent assessments to monitor for any signs of bleeding or other adverse reactions.
5. Follow-up imaging to ensure efficacy and monitor for potential complications.

Duration

Approximately 60 minutes for the administration of the medication.

Setting

Hospital setting, typically in an emergency department or specialized stroke unit.

Personnel

• Emergency physicians or neurologists.
• Nurses with training in stroke care.
• Radiologists for imaging studies.
• Pharmacists for medication preparation and dosing.

Risks and Complications

• Bleeding, particularly intracranial hemorrhage.
• Allergic reactions to the medication.
• Reperfusion injury where restored blood flow causes additional damage.
• Secondary embolism.

Benefits

• Potential to significantly reduce disability following a stroke.
• Increased likelihood of regaining independence and performing daily activities.
• Immediate effects in terms of improved blood flow.

Recovery

• Close monitoring in a hospital stroke unit for at least 24 hours post-administration.
• Regular neurological assessments.
• Avoiding any invasive procedures for at least 24 hours.
• Follow-up imaging to monitor recovery and assess for complications.
• Rehabilitation to support recovery of lost functions.

Alternatives

• Mechanical thrombectomy, where a device is used to remove the clot from the blood vessel.
• Antiplatelet or anticoagulant medications.
• Conservative medical management without immediate clot dissolution.

Patient Experience

• Patients may feel a warming sensation when the medication starts to work.
• Close observation in a hospital setting which might be uncomfortable but necessary.
• Patients can expect tight monitoring to ensure any complications are promptly managed.
• Pain management and comfort measures are employed as necessary.