What blood pressure should be maintained post-TNK administration?

From the Research

Blood pressure should be maintained below 180/105 mmHg after TNK administration. This target is crucial because elevated blood pressure increases the risk of intracranial hemorrhage, which is the most serious complication of thrombolytic therapy. To achieve this goal, continuous blood pressure monitoring is essential during the first 24 hours post-administration. If blood pressure exceeds this threshold, antihypertensive medications such as labetalol (10-20 mg IV bolus, followed by infusion if needed), nicardipine (5 mg/hour IV, titrated up by 2.5 mg/hour every 5-15 minutes), or clevidipine (1-2 mg/hour IV, doubled every 90 seconds as needed) should be administered promptly. These medications offer rapid onset and short half-life, allowing for precise blood pressure control. The physiological basis for this approach is that TNK dissolves clots by activating plasminogen to plasmin, which degrades fibrin in thrombi, but this same mechanism can compromise vascular integrity, particularly in the brain where elevated pressure can rupture weakened vessels 1.

Key Considerations

• The choice of antihypertensive medication should be based on the patient's clinical profile and the potential for adverse effects.
• Nicardipine and labetalol have been shown to be effective in managing hypertension in stroke patients, with similar efficacy and safety profiles 2, 3.
• The goal of blood pressure management is to minimize the risk of intracranial hemorrhage while maintaining adequate cerebral perfusion.
• Continuous blood pressure monitoring and prompt adjustment of antihypertensive medications are essential to achieve this goal.

Management Strategy

• Monitor blood pressure continuously during the first 24 hours post-TNK administration.
• If blood pressure exceeds 180/105 mmHg, administer antihypertensive medications promptly.
• Choose an antihypertensive medication based on the patient's clinical profile and potential for adverse effects.
• Titrate the medication to achieve a blood pressure below 180/105 mmHg, while minimizing the risk of hypotension.