NSTEMI

Question 1

what are the TIMI risk scoring?

Answer 1

you get 1 point for each of the following:

1. age > 65
2. 3 or more coronary RF
3. prior coronary stenosis of 50% or more
4. ST deviation on presenting ECG
5. 2 or more anginal episodes in prior 24 hours
6. aspirin use in prior 7 days
7. elevated serum cardiac markers

Question 2

what is the role of tirofiban in UAP?

Answer 2

it is for use if there is breakthrough ischaemia after patient has had DAPT and LMWH.

Question 3

describe the mechanism of action of the anti platelet agents

Answer 3

see image

Question 4

why is clopidogrel now used less than ticagrelor?

what mechanism particularly?

Answer 4

there is such a thing as a clopidogrel non-responder. This is due to the fact that clopidogrel needs activation from its pro-drug state

Question 5

what is the role of tirofiban?

Answer 5

it is used when a patient has breakthrough ischaemia.

we don’t use it normally, because it is associated with increased bleeding risk

Question 6

what anti-protein clotting agent do you use on the day of an angiogram/PCI?

Answer 6

we would omit enoxaparin and give bivalirudin during the PCI