ACS pt 3 Flashcards
resident
what drugs are GP IIb/IIIa inhibitors?
abciximab
eptifibatide
tirofiban
when would GP IIb/IIIa inhibitors be used in practice?
potent and expensive IV antiplatelets given in addition to DAPT at time of PCI
in what cases should GP IIb/IIIa inhibitors be used in NSTEMI?
with high risk features such as positive troponin
why are GP IIb/IIIa inhibitors not used routinely?
case by case basis due to increased risk of bleeding when adding a third antiplatelet
majority of trials for drugs were conducted before DAPT was standard of care
when should GP IIb/IIIa inhibitors be used in STEMI?
during PCI when there is complication due to large thrombus burden
use during procedure if thrombus develops or low blood after stenting –> bail out therapy
what GP IIb/IIIa inhibitors have renal adjustment doseing?
eptifibatide and tirofiban
why is anticoagulation therapy recommended?
to improve vessel patency and prevent re-occclusion
used in addition to antiplatelet therapy
what type of activity does UFH have?
anti-xa and anti-IIa
what is the risk associated with UFH?
HIT (heparin induced thrombocytopenia) caused by formation of antibodies that activate platelet
leads to drop in platelet count and increased thrombosis
if HIT is suspected, what should be calculated?
the 4Ts –> thrombocytopenia, timing of platelet count drop, thrombosis, and other causes
what screening test are available to test for HIT?
enzyme-linked immunosorbent assay (ELISA)
serotonin release assay (SRA)
what is the difference between ELISA and SRA?
ELISA - quick, high false positive rate
SRA - gold standard for diagnosis, often a send out lab
should a patient with a history of HIT be re-challenged with UFH or LMWH?
no
how is UFH dosed and why is it dosed like this?
administered as a continuous infusion based on the aPPT or ACT
has quick onset and short half life
what type of activity does enoxaparin have?
anti-xa and anti-IIa that has a higher ratio compared to UFH
how is enoxaparin eliminated?
via the kidney
accumulates in renal impairment (avoid)
what is bivalirudin?
direct thrombin inhibitor
cannot be used together with GP IIb/IIIa inhibitors except to bail out
what are some maybes associated with bivalirudin?
may not be as effective for MACE and stent thrombosis
may have lower bleeding risk
what is fondaparinux?
a factor Xa inhibitor that is not commonly used
can be used with history of HIT though
why should you not use fondaparinux alone for PCI?
high rates of thrombosis
if already giving fondaparinux, then give with UFH or angiomax in addition
when is fondaparinux CI?
if CrCl is under 30 mL/min
what is the maintenance dosin for enoxaparin?
1mg/kg SQ q12h OR
if over 75 years, reduce to 0.75mg SQ q12h
for the different areas of UA/NSTEMI and STEMI, when should UFH as an anticoagulant be utilized?
IGS - Yes (for 48 hours)
EIS - Yes (until PCI)
Fibrinolytic - Yes (for 48 hours)
PCI - Yes (until PCI)
for the different areas of UA/NSTEMI and STEMI, when should bivalirudin as an anticoagulant be utilized?
IGS - No
EIS - Yes (until PCI)
Fibrinolytic - No (may consider for HIT)
PCI - Yes (until PCI and then preferred in high bleeding risk pts)
