Suspect Major Bleeding

• Stop TPA infusion if still in progress
• Stat CT scan without contrast of head
• Hematocrit, hemoglobin, PT, PTT, platelet count, fibrinogen, D-dimer
• Repeat every 2 hours until bleeding is controlled.

 For major hemorrhage or intracranial hemorrhage

• Give fresh frozen plasma 2 units every 6 hours for 24 hours.
• Give cryoprecipitate 5 units. If fibrinogen level < 200mg/dl at 1 hour, repeat cryoprecipitate dose.
• Give platelets 4 units.
• As last resort May give aminocaproic acid (Amicar) 5g IV in 250ml of normal saline over 1 hour
• Neurosurgical consultation.