STEMI reperfusion (lytics) Flashcards
What percentage of the time do lytics get timi 3 flow?
40-60% (tNK had the highest at 63%, followed by r-PA or Reteplace at 60%).
chart of TPA drugs (4)
fibrin spe
dose
Antigenic
Systemic fibrinogen depletion
Timi grade 3 flow %
SK Alteplase (TPA). Reteplace. TNK
fibrin spe. none. ++. ++ ++++
dose 1.5 mil < 100 mg over 90. 10 U x 2 30-50
Antigenic Yes. No No No
Systemic fibrinogen depletion. Marked. Mild Moderate. Mild
Timi grade 3 flow % 40 54 60 63
Abs CI fibrinolyis
relative
Abs
prior ICH at any point
Cerebral vascular lesion AVM
known malignant ICH
stroke within 3 month except acute stroke
Ao Diss
bleeding
closed head or facila trauma
Severe HTN nonresponive to medications
\
relative
severe HTN > 180
ischemic stroke any
dementia
prolonged CPR > 10 min
vasc procedures
Ajunctive rx with fibrinolyisi
heparin 60 u / kg bolus (max 4 k) x 48 hours or until cath lab, and 12 U per Kg ggt
Enox Age< 75 30 mg IV bolus in 15 followed by 1 mg/kg, greater than 75 no bolus then 0l75 mg/kg sq, 1/ mg kg /q24
Fonda Cr Cl > 30 CI
ASA 162-325 oad then 81 daily
plavix 300 mg load if < 75 and if over or = 75 just do 75
P2Y12 with TPA
300 mg if < 75 and no load 75 if over or equal 75
PCI vs. lysis when
FMC to device <90 min if present to pci capable hospital
FMC to device < 120 if present to outside hosp.
EMS transport directly to PCI capable center as long as FMC to device is expedted to be 90 min or less.
Fibrinolusis should be admin at non-PCI capable centers when FMC to device expected to exceed 120 minutes.
Stemi what is the general time limit to do pci from the last set of sx
12 hrs
12 hours
from last sx for stemi unless in shock then do PCI whenever (really less than 24 could consider but gl say 12
12 -24 hours
gray hour oat was 24 h.
routine aspiration thrombectomy
class III “routine”
PRAMI
2 other similar trials
Non culprite pci had improved outcomes (outside of shock)
also cvlprit and primulti less repeat MI –> can do what you want when. you want to do it thake home message
