Thrombolytics for STEMI
Revision as of 07:00, 5 March 2019 by Rossdonaldson1 (talk | contribs)
Overview
Indications[1][2]
- Chest pain > 30 min but less than 12 hrs, not relieved by NTG
- PCI greater than 120 min away[3]
- ECG criteria of STEMI
- STE in 2 contiguous leads
- Posterior STEMI
- LBBB with Sgarbossa criteria
Contraindications
Absolute
- Any prior ICH
- Known structural cerebral vascular lesion (AVM)
- Known intracranial neoplasm
- Ischemic stroke within 3 mo
- Active internal bleeding (excluding menses)
- Suspected aortic dissection or pericarditis
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
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
See Also
External Links
References
- ↑ ACLS Training Center. Fibrinolytic Checklist for STEMI. https://www.acls.net/images/algo-fibrinolytic.pdf
- ↑ Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview*a3.
- ↑ [AHA 2013 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction PDF