tPA Stroke Dosing
Determine the total dose, bolus, and infusion amounts for IV alteplase (tPA) based on patient weight and time since last known well. This tool follows AHA/ASA guidelines for acute ischemic stroke.
Standard IV alteplase window: ≤4.5 hours in selected patients.
How to Use This Calculator
Confirm eligibility
Ensure onset within 4.5 hours, no intracranial hemorrhage, BP <185/110 mmHg, and no major contraindications.
Enter accurate weight
Use actual or estimated weight. The dose caps at 90 mg (100 kg).
Prepare bolus and infusion
Administer 10% as IV bolus over 1 minute, then infuse remainder over 60 minutes with infusion pump.
Formula
Total dose: 0.9 mg/kg (max 90 mg).
Based on AHA/ASA Acute Ischemic Stroke Guidelines (2019 update).
About IV Alteplase
Intravenous alteplase (tPA) is the only FDA-approved thrombolytic for acute ischemic stroke. Treatment is time-sensitive and requires multidisciplinary coordination. Before administration, exclude hemorrhage via non-contrast CT, review contraindications (recent surgery, bleeding diathesis, thrombocytopenia), and control blood pressure. After infusion, monitor for hemorrhagic transformation, angioedema, and neurological changes. Avoid antiplatelet and anticoagulant therapy for 24 hours post-dose until follow-up imaging excludes hemorrhage.
Frequently Asked Questions
What if BP is above 185/110 mmHg?
Use IV labetalol or nicardipine to lower BP before tPA. Maintain <180/105 during and 24 h after infusion.
Can tPA be given after 4.5 hours?
Extended window up to 9 hours requires advanced imaging (perfusion mismatch) and neurointerventional consultation.
How soon after tPA can antithrombotics be started?
Delay antiplatelets and anticoagulants for at least 24 hours. Obtain repeat CT/MRI before initiation.
What if patient is on DOAC or warfarin?
Generally contraindicated unless coagulation labs within normal limits and sufficient time since last dose; consult neurology.
How to manage symptomatic ICH post tPA?
Stop infusion, obtain emergent CT, give cryoprecipitate, platelets, tranexamic acid/aminocaproic acid per protocol, and involve neurosurgery.