Question

A 68-year-old with acute right-sided weakness arrived 125 minutes after last-known-well. Blood pressure is 182/100 mm Hg, glucose 110 mg/dL, non-contrast head CT shows no haemorrhage, and he is not taking anticoagulants. What is the most appropriate next step?

Accepted Answer

Administer intravenous alteplase 0.9 mg/kg (10% bolus, remainder over 60 minutes; max 90 mg) now

Answer

Start aspirin 325 mg immediately

Answer

Begin unfractionated heparin infusion

Answer

Defer reperfusion until blood pressure is <160/90 mm Hg

Answer

Obtain CT angiography first and delay therapy until imaging

Practice question

A 68-year-old with acute right-sided weakness arrived 125 minutes after last-known-well. Blood pressure is 182/100 mm Hg, glucose 110 mg/dL, non-contrast head CT shows no haemorrhage, and he is not taking anticoagulants. What is the most appropriate next step?