Thrombolytics for STEMI

Revision as of 08:21, 5 March 2019 by Rossdonaldson1 (talk | contribs) (Complications)

Overview

    • If receive fibrinolytics also give anticoagulants for minimum of 48hr, and preferable the length of the hospitalization
    • Fibrinolytic treatment within 3hr resulted in >30 lives saved per 1000 patients

Indications[1][2]

  • Chest pain >30 min but <12 hrs, not relieved by nitroglycerin
  • PCI greater than 120 min away[3]
  • ECG criteria of STEMI
    • STE in 2 contiguous leads
    • Posterior STEMI
    • LBBB with Sgarbossa criteria

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

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