Is fibrinolysis preferred treatment for STEMI?
For most patients with acute STEMI, we prefer primary PCI rather than fibrinolysis. However, fibrinolytic therapy should be used if timely primary PCI is not available.
Which patients are candidates for fibrinolytic therapy?
Fibrinolytic therapy works by dissolving clots which are obstructing blood flow to the brain. In order to be considered a suitable candidate for the therapy, patients must be over the age of 18 and have a firm diagnosis of ischemic stroke with deficits.
What is the preferred treatment for STEMI?
There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI.
When should fibrinolytic therapy be administered in STEMI?
Efficacy. For optimal results, fibrinolytic therapy should be administered as early as possible, preferably within the first 3 to 6 hours and potentially up to 12 hours after the onset of symptoms (Figure I in the Data Supplement). After 3 hours of symptom onset the clinical benefit of fibrinolysis markedly decreases.
Why is PCI preferred over fibrinolytics?
Among the strategies evaluated, primary PCI was associated with the lowest risk of mortality, nonfatal reinfarction, and stroke. For mortality, primary PCI had an odds ratio of 0.73 (95% CI , 0.61–0.89) when compared with fibrinolytic therapy.
Can you give fibrinolytics in Nstemi?
Fibrinolytic therapies should not be used in NSTEMI. When NSTEMI has been diagnosed, patients should be admitted to cardiac care units for further management. Beta-blocker therapy should be started within 24 hours after the presentation in patients who do not have a contraindication.
Which patient is the best candidate for thrombolytic therapy?
Who is a candidate for thrombolytic therapy?
- Blood glucose greater than 50 mg/dL (2.7 mmol)
- No seizure with residual post-seizure impairments.
- Computed tomography (CT) scan does not show evidence of tissue death in multiple brain lobes.
- The patient and family understand the potential risks and benefits of therapy.
Why is fibrinolytic contraindicated in Nstemi?
In NSTEMI the blood flow is present but limited by stenosis. In NSTEMI, thrombolytics must be avoided as there is no clear benefit of their use. If the condition stays stable a cardiac stress test may be offered, and if needed subsequent revascularization will be carried out to restore a normal blood flow.
What drugs are used for STEMI?
Initial medical management of STEMI consists of relief of ischemic pain with nitrates and morphine, antithrombotic measures including antiplatelet agents (aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors), and systemic anticoagulation (heparin or bivalirudin) and beta-adrenergic blockade.
What is a contraindication to thrombolytic therapy for a STEMI patient?
When the decision to treat a patient experiencing a STEMI with fibrinolytic therapy is made, because primary PCI is not available in a timely fashion, contraindications must be considered; suspected aortic dissection, active bleeding (excluding menses) or a bleeding diathesis are contraindications to fibrinolytic …
What is better PCI or thrombolysis?
Primary percutaneous coronary intervention (PCI), when performed in a timely manner, is preferred to fibrinolytic therapy for reperfusion therapy during ST‐segment–elevation myocardial infarction (STEMI).
Why is PCI preferred over thrombolysis?
Alternatively, PCI is preferred if the medical contact-to-balloon time is less than 90 min and the delta time is less than 60 min, or if there are other reasons (eg, contraindications to thrombolysis, symptom onset of more than 3 h or high-risk STEMI [cardiogenic shock, or Killip class 3 or greater]).
Why is fibrinolytic therapy not used in NSTEMI?
In NSTEMI, thrombolytics must be avoided as there is no clear benefit of their use. If the condition stays stable a cardiac stress test may be offered, and if needed subsequent revascularization will be carried out to restore a normal blood flow.
Why are STEMI and NSTEMI treated differently?
Equally important, NSTEMI heart attacks are caused by different types of blood clots than STEMI heart attacks, with differing amounts of clotting proteins and platelet blood cells. Therefore, the treatment of NSTEMI heart attacks differs from the treatment of STEMI heart attacks.
What are contraindications to fibrinolytic therapy?
Who is not a candidate for thrombolytic therapy?
Thrombolytic therapy cannot be recommended for persons excluded from the NINDS Study6 for one of the following reasons: (1) current use of oral anticoagulants or a prothrombin time greater than 15 seconds (International Normalized Ratio [INR] greater than 1.7); (2) use of heparin in the previous 48 hours and a …
What four drugs are recommended for post MI patients?
Patients should be placed on the following medications: antiplatelet agents, (meta-analysis for aspirin, multiple randomized controlled trials [RCTs] for aspirin plus clopidogrel); a statin; atorvastatin has the best evidence (a single RCT); a beta-blocker (meta-analysis); renin-angiotensin-aldosterone system blockers.
Why morphine is used in the treatment of MI?
As a potent opioid, morphine has seemed to be the ideal analgesic. It has innate hemodynamic effects that are beneficial during MI. It decreases heart rate, blood pressure, and venous return, and it may also stimulate local histamine-mediated processes. Theoretically, this reduces myocardial oxygen demand.
Why is PCI preferred over Fibrinolytics?
Which of the following is an absolute contraindication for fibrinolysis in STEMI?
Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy.
How long after STEMI can you do PCI?
Primary PCI is recommended in unstable late presenters, whereas routine PCI should only be considered in stable STEMI patients presenting 12 to 48 hours after symptom onset.
What thrombolytic is given for an MI?
Alteplase is FDA-approved for treatment of ST-elevation myocardial infarction (STEMI), AIS, acute massive PE, and occluded CVADs. At present, it is the only thrombolytic drug approved for AIS. In theory, alteplase should be effective only at the surface of fibrin clot.
What is the first line treatment for myocardial infarction?
All patients with a suspected myocardial infarction should be given aspirin. It is a powerful antiplatelet drug, with a rapid effect, which reduces mortality by 20%. Aspirin, 150-300 mg, should be swallowed as early as possible.
Is Mona used for STEMI?
MONA. Immediate treatment typically includes morphine, oxygen, nitroglycerin and aspirin (MONA). Morphine Sulfate: Morphine sulfate is the analgesic of choice for the management of chest pain associated with STEMI. Administer administered in 2 – 4 mg IV repeated at 5- to 15-minute intervals until pain is relieved.