What BP monitoring schedule is recommended after starting thrombolytic therapy?

• A. Monitor every 5 minutes for 60 minutes, then hourly
• B. Monitor every 60 minutes for 24 hours
• C. Monitor every 30 minutes for 2 hours, then every 2 hours
• D. Monitor every 15 minutes for 2 hours from initiation, then every 30 minutes for 6 hours, then every hour for 16 hours

Answer: (D)

After starting thrombolytic therapy, blood pressure must be watched very closely because high BP can trigger bleed around the treated clot. The safest approach is to monitor BP at very short intervals early on, when the risk of hemorrhagic transformation is highest, and then gradually space out monitoring as the risk decreases. The recommended pattern is to check BP every 15 minutes for the first 2 hours, then every 30 minutes for the next 6 hours, and finally every hour for the following 16 hours. Keeping BP generally under 180/105 helps minimize bleeding risk during this critical period. Other patterns don’t provide the same level of early detection or align with recommended practice, which is why this schedule is preferred.