STEMI

Question 1

Primary PCI strongly preferred, especially for patients with?

Answer 1

cardiogenic shock, heart failure, late presentation, or contraindications to fibrinolysis.

Question 2

For patients with symptoms of >12 hours

Answer 2

• liệu pháp tiêu sợi huyết không được chỉ định,
• nhưng có thể cân nhắc sử dụng PCI, đặc biệt đối với những bệnh nhân có bằng chứng thiếu máu cục bộ hoặc những người có nguy cơ tử vong cao.

Question 3

Treat with fibrinolysis if

Answer 3

PCI unavailable within 120 minutes of first medical contact, symptoms <12 hours, and no contraindications.

Question 4

oral antiplatelet therapy

Patients treated with fibrinolytic therapy:

Answer 4

Clopidogrel
loading dose 300 mg =< 75 tuổi
loading dose of 75 mg > 75 tuổi.

Question 5

Patients treated with no reperfusion therapy:

oral antiplatelet therapy

Answer 5

Ticagrelor

loading dose 180 mg.

Question 6

Patients treated with primary PCI:

oral antiplatelet therapy

Answer 6

Ticagrelor loading dose of 180 mg or prasugrel loading dose of 60 mg
if no contraindications

Question 7

Patients treated with primary PCI:
(oral antiplatelet therapy)
high risk of bleeding or those for whom prasugrel or ticagrelor cannot be used

Answer 7

clopidogrel 600 mg

Question 8

Ticagrelor/prasugrel contraindications

Answer 8

prior stroke or TIA, or relative contraindications for prasugrel such as those age 75 years or older, weight less than 60 kg

Question 9

anticoagulant therapy

For patients treated with primary PCI

Answer 9

• Ticagrelor or prasugrel) –> UFH

- Clopidogrel–> we prefer bivalirudin.

Question 10

Dosing of UFH:

For patients treated with primary PCI

Answer 10

IV bolus of 50 to 70 units/kg up to a maximum of 5000 units.

Question 11

For patients treated with fibrinolysis, anticoagulant therapy

Answer 11

1. we prefer enoxaparin for patients not at high bleeding risk
2. or fondaparinux for those at high bleeding risk.
3. For those patients in whom PCI is possible or likely after fibrinolytic therapy, UFH is reasonable.

Question 12

Dosing of enoxaparin, For patients treated with fibrinolysis

Patients <75 years:

Answer 12

Loading dose of 30 mg IV bolus followed by 1 mg/kg subcutaneously every 12 hours; maximum of 100 mg for the first two subcutaneous doses.
Dose adjustment for renal impairment (CrCl <30 mL/minute)*: Loading dose of 30 mg IV followed by 1 mg/kg subcutaneously every 24 hours.

Question 13

Dosing of enoxaparin, For patients treated with fibrinolysis

Patients ≥75 years:

Answer 13

No IV loading dose. Administer 0.75 mg/kg subcutaneously every 12 hours; maximum of 75 mg for the first two doses.
Dose adjustment for renal impairment (CrCl <30 mL/minute)*: No IV loading dose. Administer 1 mg/kg subcutaneously every 24 hours.

Question 14

Supplemental IV bolus dose for patients who will receive PCI after >1 dose of therapeutic enoxaparin:

Answer 14

• 8 to 12 hours earlier 0.3 mg/kg if last enoxaparin ;
• trong vòng 8 giờ: không dùng
• > 12 giờ use UFH

Question 15

For patients not receiving reperfusion therapy,

Answer 15

enoxaparin or UFH.

Question 16

For patients not receiving reperfusion therapy,

Dosing of enoxaparin:

Answer 16

Dosing of enoxaparin: Dose same as for patients treated with fibrinolysis (refer to section 2 above).