Difference between revisions of "Thrombolytics for STEMI"

(Overview)
(References)
 
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==Overview==
 
==Overview==
#*If receive fibrinolytics also give anticoagulants for minimum of 48hr, and preferable the length of the hospitalization
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*Fibrinolytic treatment within 3hr resulted in >30 lives saved per 1000 patients
#*Fibrinolytic treatment within 3hr resulted in >30 lives saved per 1000 patients
 
  
 
==Indications<ref>ACLS Training Center. Fibrinolytic Checklist for STEMI. https://www.acls.net/images/algo-fibrinolytic.pdf</ref><ref>Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview*a3.</ref>==
 
==Indications<ref>ACLS Training Center. Fibrinolytic Checklist for STEMI. https://www.acls.net/images/algo-fibrinolytic.pdf</ref><ref>Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview*a3.</ref>==
 
*[[Chest pain]] >30 min but <12 hrs, not relieved by [[nitroglycerin]]
 
*[[Chest pain]] >30 min but <12 hrs, not relieved by [[nitroglycerin]]
 
*PCI greater than 120 min away<ref> [AHA 2013 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction [https://www.heart.org/idc/groups/heart-public/@wcm/@mwa/documents/downloadable/ucm_453635.pdf PDF]</ref>
 
*PCI greater than 120 min away<ref> [AHA 2013 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction [https://www.heart.org/idc/groups/heart-public/@wcm/@mwa/documents/downloadable/ucm_453635.pdf PDF]</ref>
*[[ECG]] criteria of STEMI
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*[[ECG]] criteria of [[STEMI]]
**STE in 2 contiguous leads
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**[[ST elevation|STE]] in 2 contiguous leads
**Posterior STEMI
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**Posterior [[STEMI]]
**LBBB with Sgarbossa criteria
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**[[LBBB]] with [[Sgarbossa criteria]]
  
 
==Contraindications==
 
==Contraindications==
 
===Absolute===
 
===Absolute===
 
*Any prior [[ICH]]  
 
*Any prior [[ICH]]  
*Known structural cerebral vascular lesion (AVM)  
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*Known structural cerebral vascular lesion ([[AVM]])  
 
*Known [[intracranial neoplasm]]
 
*Known [[intracranial neoplasm]]
 
*[[Ischemic stroke]] within 3 mo  
 
*[[Ischemic stroke]] within 3 mo  
*Active internal bleeding (excluding menses)  
+
*Active internal [[hemorrhage|bleeding]] (excluding menses)  
 
*Suspected [[aortic dissection]] or [[pericarditis]]
 
*Suspected [[aortic dissection]] or [[pericarditis]]
  
 
===Relative===
 
===Relative===
*Severe uncontrolled BP (>180/110)  
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*Severe uncontrolled [[hypertension|BP]] (>180/110)  
*History of chronic severe poorly controlled hypertension  
+
*History of chronic severe poorly controlled [[hypertension]]
*History of prior ischemic stroke >3 mo  
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*History of prior [[ischemic stroke]] >3 mo  
 
*Known intracranial pathology not covered in absolute contraindications  
 
*Known intracranial pathology not covered in absolute contraindications  
*Current use of anticoagulants with known INR >2–3  
+
*Current use of [[anticoagulants]] with known INR >2–3  
*Known bleeding diathesis  
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*Known [[coagulopathy|bleeding diathesis]]
*Recent trauma (past 2 wk)  
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*Recent [[trauma]] (past 2 wk)  
*Prolonged CPR (>10 min)  
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*Prolonged [[CPR]] (>10 min)  
 
*Major surgery (<3 wk)  
 
*Major surgery (<3 wk)  
 
*Noncompressible vascular punctures (e.g. IJ, subclavian)  
 
*Noncompressible vascular punctures (e.g. IJ, subclavian)  
 
*Recent internal bleeding (within 2–4 wk)  
 
*Recent internal bleeding (within 2–4 wk)  
 
*Patients treated previously with streptokinase should not receive streptokinase a 2nd time  
 
*Patients treated previously with streptokinase should not receive streptokinase a 2nd time  
*Pregnancy  
+
*[[Pregnancy]]
 
*Active [[peptic ulcer disease]]  
 
*Active [[peptic ulcer disease]]  
 
*Other medical conditions likely to increase risk of bleeding (diabetic retinopathy, etc)
 
*Other medical conditions likely to increase risk of bleeding (diabetic retinopathy, etc)
  
 
==Administration==
 
==Administration==
 +
''If receive fibrinolytics also give anticoagulants for minimum of 48hr, and preferable the length of the hospitalization''
 
{{Thrombolytics STEMI}}
 
{{Thrombolytics STEMI}}
  
 
==Complications==
 
==Complications==
 
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*0.5-1% of patients suffer [[ICH]]
  
 
==See Also==
 
==See Also==
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[[Category:Procedures]]
 
[[Category:Procedures]]
 +
[[Category:Cardiology]]
 +
[[Category:Pharmacology]]
 +
[[Category:Critical Care]]

Latest revision as of 15:51, 10 October 2019

Overview

  • Fibrinolytic treatment within 3hr resulted in >30 lives saved per 1000 patients

Indications[1][2]

Contraindications

Absolute

Relative

  • Severe uncontrolled BP (>180/110)
  • History of chronic severe poorly controlled hypertension
  • History of prior ischemic stroke >3 mo
  • Known intracranial pathology not covered in absolute contraindications
  • Current use of anticoagulants with known INR >2–3
  • Known bleeding diathesis
  • Recent trauma (past 2 wk)
  • Prolonged CPR (>10 min)
  • Major surgery (<3 wk)
  • Noncompressible vascular punctures (e.g. IJ, subclavian)
  • Recent internal bleeding (within 2–4 wk)
  • Patients treated previously with streptokinase should not receive streptokinase a 2nd time
  • Pregnancy
  • Active peptic ulcer disease
  • Other medical conditions likely to increase risk of bleeding (diabetic retinopathy, etc)

Administration

If receive fibrinolytics also give anticoagulants for minimum of 48hr, and preferable the length of the hospitalization

Alteplase (TPA)

Dosing based on patient weight:

  • 67kg: Infuse 15mg IV over 1-2min; then 50mg over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
  • ≤67kg: Infuse 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) over 30 min; then 0.5 mg/kg over 60min (max 35 mg)

Tenecteplase (TNKase)

  • Reconstitute 50 mg vial in 10 mL sterile water (5 mg/mL)
  • < 60 kg = 30 mg IV push over 5 seconds
  • 60-69 kg = 35 mg IV push over 5 seconds
  • 70-79 kg = 40 mg IV push over 5 seconds
  • 80-89 kg = 45 mg IV push over 5 seconds
  • > 90 kg = 50 mg IV push over 5 seconds

Complications

  • 0.5-1% of patients suffer ICH

See Also

External Links

References

  1. ACLS Training Center. Fibrinolytic Checklist for STEMI. https://www.acls.net/images/algo-fibrinolytic.pdf
  2. Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview*a3.
  3. [AHA 2013 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction PDF