Is is safe to give tPA/thrombolytics to someone who just underwent cardiac catheterization?

At my institution, we recently discussed a case of a patient with acute stroke in the setting of cardiac catheterization (right femoral access). The decision to push tPA was a tricky one, because he had just been cathed. When is it ok? When is it NOT ok?

Here are relative and absolute contraindications (respectively) for giving tPA:

 

As you can see, arterial puncture at a noncompressible site is a relative contraindication for tPA. So depending on where the puncture site was…the typical site for an arterial stick in a catheterization is between the bifurcation of the SFA and PFA and the branching point of the inferior epigastric artery. Typical site=compressible, “high stick”=noncompressible. If there is a “high stick,” tPA will confer a much higher risk of RP bleed and hemorrhage, and should be avoided.

Screen Shot 2018-02-06 at 11.54.23 AM

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s