Management of intracerebral hemorrhage after thrombolysis for ischemic stroke

1. Consider bleeding the likely cause of neurologic worsening after use of a thrombolytic drug until a brain scan confirms or refutes hemorrhage.
2. Immediately discontinue ongoing infusion of thrombolytic drug.
3. Obtain emergent head CT or MRI stat.
4. Obtain blood samples for type and crossmatch, prothrombin time, activated partial thromboplastin time, platelet count, and fibrinogen.
5. If intracerebral hemorrhage is confirmed by imaging:
Give 10 units of cryoprecipitate to increase the levels of fibrinogen and factor VIII
Give 6 to 8 units of platelets
In patients receiving unfractionated heparin (UFH) for any reason, consider giving 1 mg of protamine for every 100 U of UFH received in the preceding four hours.
6. Obtain neurosurgical consultation and consider evacuation of the hematoma.