Search
- A persistent systolic blood pressure (BP) > 185 and/or a diastolic BP > 110, is a contraindication to thrombolytic therapy in acute ischemic stroke patients.
- In cases such as these, the following antihypertensive regimens may be used in order to attempt to proceed with administering thrombolytic therapy as soon as possible:
- Nicardipine infusion 5 mg/hour; titrate up by 2.5 mg/h every 5 - 15 minutes as needed to a maximum of 15 mg/h; reduce to 3 mg/h once desired BP is reached,
- Labetalol 10-20 mg IV over 1-2 minutes; may repeat once, OR
- Other agents such as hydralazine or enalapril when appropriate.
- Note that these options are based on 2010 recommendations which no longer include the use of nitropaste, as was the case with the prior recommendations from 2007.
References
- Jauch EC, Cucchiara B, Adeye O, et al. Part 11: Adult Stroke. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (suppl 3): S818-S828.