Bleeding Complications

Bleeding complications are likely to be rare but they may be encountered and should be closely watched. Neurological checks should occur every 15 minutes for the first hour and then 30 minutes for the next 6 hours to monitor for intracranial bleeding. Normotension should be strived for while SBP > 160 mmHg should be avoided. Once life-threatening bleeding is identified, stop all antiplatelet agents, anticoagulants, and fibrinolytics. Specific reversal therapies unique to life-threatening bleeding due to thrombolysis are listed below.38 In the case of suspected intracranial bleeding, obtain an emergent CT head and consult neurosurgery if an intracranial bleed is actually present.

1. Administer Cryoprecipitate - 10 units IV.
2. Administer tranexamic acid (TXA) – 10-15 mg/kg IV.
3. Stop all antiplatelet, anticoagulant, and fibrinolytics.