A 72-year-old female presents to the ED with sudden onset right-sided weakness and aphasia. Her symptoms began 2 hours ago. Non-contrast head CT is negative for hemorrhage. Her blood pressure is 190/100 mmHg. Which of the following is the most appropriate next step in her management for potential thrombolysis?
A
Immediately administer intravenous labetalol to lower blood pressure below 140/90 mmHg.
B
Initiate a heparin drip to prevent further clot formation.
C
Assess for contraindications to alteplase and obtain a repeat head CT in 6 hours.
D
Administer intravenous alteplase if blood pressure is maintained below 185/110 mmHg.
✓ Correct Answer: Option D
For acute ischemic stroke patients who are candidates for thrombolysis, blood pressure must be ≤185/110 mmHg prior to and for 24 hours after alteplase administration. Aggressive BP lowering below this threshold is not recommended pre-thrombolysis.
💡 Why is D) the correct answer?
The correct answer to the question "A 72-year-old female presents to the ED with sudden onset right-sided weakness and aphasia. Her symptoms began 2 hours ago. Non-contrast head CT is negative for hemorrhage. Her blood pressure is 190/100 mmHg. Which of the following is the most appropriate next step in her management for potential thrombolysis?" is Option D: Administer intravenous alteplase if blood pressure is maintained below 185/110 mmHg..
The other options — A) Immediately administer intravenous labetalol to lower blood pressure below 140/90 mmHg., B) Initiate a heparin drip to prevent further clot formation., C) Assess for contraindications to alteplase and obtain a repeat head CT in 6 hours. — are incorrect for this USMLE Exam Prep question. As explained above: For acute ischemic stroke patients who are candidates for thrombolysis, blood pressure must be ≤185/110 mmHg prior to and for 24 hours after alteplase administration. Aggressive BP lowering below thi…
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