SEDAN Score for Post-tPA Haemorrhage
Predicts risk of symptomatic intracranial haemorrhage (sICH) after IV thrombolysis (rtPA) for ischaemic stroke.
Score interpretation
SEDAN 0–1: Low risk of symptomatic ICH after tPA (~1–2%). Thrombolysis risk-benefit favourable.
→ Proceed with IV alteplase 0.9 mg/kg (max 90mg): 10% IV bolus over 1 min, remainder over 60 min. Admit to stroke unit. BP monitoring (< 185/110 before tPA, < 180/105 for 24h post). Repeat CT head at 24h. No heparin/aspirin for 24h.
SEDAN 2–3: Intermediate sICH risk. Weigh benefits vs haemorrhage risk carefully.
→ Thrombolysis still generally indicated if within time window and no absolute contraindications. Meticulous BP control. Senior stroke physician discussion. Document informed consent discussion. Enhanced post-tPA monitoring — neurological observations every 15 min for first 2 hours.
SEDAN ≥ 4: High sICH risk after tPA (> 10%). Careful risk-benefit discussion essential.
→ Discuss with senior stroke physician. Consider thrombectomy alone if large vessel occlusion and within window (bypass tPA). If tPA given: very close monitoring, low threshold for urgent CT if any neurological deterioration. If sICH suspected: stop infusion, immediate CT head, neurosurgical consultation.
Interpretation bands for the SEDAN Score. Apply clinical judgement and local guidance.
References
- Strbian D et al. The SEDAN score and the risk of post-thrombolysis intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2012.
- NICE NG128. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Tenecteplase (Stroke) · Stroke Thrombolysis
- Alteplase (Peripheral Arterial / DVT Use) · Thrombolytic — Catheter-Directed Thrombolysis / Peripheral Arterial Occlusion
- Lisinopril (HFrEF / Post-MI) · ACE Inhibitor / HFrEF
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.