MDCalc

SEDAN Score for Post-tPA Hemorrhage

Predicts risk of Symptomatic Intracerebral Hemorrhage (sICH) after tPA.

Applies to patients receiving tPA within 4.5 hours; does not apply to patients receiving endovascular treatment.

Blood sugar
Early infarct signs on initial CT
Hypoattenuation comprising <1/3 of the middle cerebral artery territory; obscuration of the lentiform nucleus or Sylvian fissure; loss of basal ganglion outline or insular ribbon; cortical sulcal effacement
Hyperdense cerebral artery sign on initial CT
Age > 75 years
NIH Stroke Scale (NIHSS) ≥ 10

Result:

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Advice
  • Consider tPA contraindications closely, as institutions may have slightly different definitions of contraindications (absolute and relative).
  • tPA for stroke should only be given in conjunction with Neurology consultation and after extensive discussion with the patient and family about risk and benefit.
  • Patients receiving tPA should be monitored in an ICU setting.
  • Even in low-risk patients, patients with changing neurologic exams or mental status should receive emergent re-imaging to assess for sICH.
  • Consider other bleeding sites (GI, GU, for example) in post-tPA patients and exercise caution with even minimally invasive procedures such as venipuncture or foley catheter placement.
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