If a femoral arterial sheath is still in place, DO NOT REMOVE IT. The sheath
should remain sutured in place while t-PA is given. Consider intra-arterial
urokinase if the sheath can be accessed and the Interventional Neuroradiology staff
is available. If not, consider giving t-PA i.v. at full dose 0.9 mg/kg. In all
cases, leave the sheath in place and check STAT PTT. Observe the groin site closely
and follow Hct and vital signs for evidence of acute blood loss. If a hematoma
forms or there is evidence of blood loss, notify Vascular Surgery and apply
pressure until hemostasis is achieved. If bleeding continues, t-PA can be
reversed with FFP, cryoprecipitate and platelets
(see bleeding after t-PA).
may choose to surgically repair the artery. If no bleeding occurs, the sheath can
be removed after 24 hours. If heparin cannot be held for sheath removal, Vascular
Surgery will surgically close the vessel in the operating room.
If a femoral arterial sheath has been pulled within 2 weeks, carefully weigh the risk
of bleeding against the anticipated benefit of t-PA therapy. If t-PA is given,
notify Vascular Surgery prior to drug administration. Then observe the groin site
closely and follow Hct and vital signs for evidence of acute blood loss.
(Occult blood loss may occur into the retroperitoneum.) If any hematoma forms or there
is evidence of acute blood loss, notify Vascular Surgery and apply direct pressure
until hemostasis is achieved. If occult blood loss occurs, obtain an abdominal CT to
look for retroperitoneal hematoma. If bleeding continues, t-PA can be reversed with
FFP, cryoprecipitate, and platelets (see bleeding after t-PA).
Reviewed/Approved by: Schwamm, Lee, M.D. on behalf of ASQT
Last updated: 12/23/2009
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