Download presentation
Presentation is loading. Please wait.
Published byChristian Davidson Modified over 6 years ago
1
Guidelines for the Management of Patients With ST- Elevation Myocardial Infarction Adapted from Focused Updates: ACC/AHA 2009
2
Classes of Recommendations
I=Should (Recommended) IIa = Is Reasonable IIb = May be considered III = Is not recommended
3
Levels of Evidences (LOE)
A = Multiple RCTs or meta-analyses B = One RCT or observational study C = Experts’ opinions
4
Updated Recommendations
Glycoprotein (GP) IIb/IIIa receptor antagonists Thienopyridines Parenteral anticoagulants Transfer for PCI
5
Updated Recommendation
CLASS I STEMI management should include ASA+ thienopyridine + anticoagulant.
6
GP IIb/IIIa Receptor Antagonist
Class IIa In selected patients at the time of primary PCI (with or without stenting) Class IIb GP IIb/IIIa receptor antagonists (before arrival in the catheterization laboratory (uncertain benefit). LOE=Level Of Evidence
7
Thienopyridine Primary PCI Loading of
At least Clopidogrel 300 to 600 mg OR Prasugrel 60 mg
8
Thienopyridine Non-Primary PCI
If patient has received non fibrin-specific FL, <48 hr, 300 mg Clopidogrel > 48 hr, mg Clopidogrel If patient has received fibrin-specific FL, <24 hr 300 mg Clopidogrel >24 hr mg Clopidogrel
9
Thienopyridine Non-Primary PCI If patient did not receive FL, or
Clopidogrel 300 to 600 mg or Prasugrel 60 mg (once the coronary anatomy is known and PCI is planned)
10
Duration of Thienopyridine
BMS Stent 12-month Clopidogrel 75 mg or Prasugrel 10 mg DES Stent Thienopyridines may be considered >15 months
11
Prasugrel - Precautions
NO data after FL. In these pts, use Clopidogrel Contra-indicated for patients less than 60 kg Contra-indicated in pts with prior TIA/CVA Not recommended in ≥75 yrs old To be given at the time of PCI only
12
Before CABG Stop Clopidogrel x 5 days Stop Prasugrel x 7 days
13
Parenteral Anticoagulants
Class I Recommendation for PCI Unfractionated heparin (UFH) (LOE:C) Enoxaparin (LOE:B) last SC dose >8 hrs, 0.3 mg/kg of iv Last SC dose <8 hours, no additional enoxaparin Fondaparinux, additional anti-II anticoagulants in the cath lab(LOE:C) Bivalirudin is useful with or without UFH. (LOE:B)
14
Parenteral Anticoagulants
Class IIa (new recommendation) In patients at high risk of bleeding, bivalirudin anticoagulation is reasonable. (LOE:B)
15
Recommendations for Triage and Transfer for PCI
Class I (new recommendation) STEMI system of care Multidisciplinary team meetings (EMS, referral and PCI hospitals) Prehospital identification and activation; Destination protocols for PCI hospitals; Transfer protocols for primary PCI candidates, FL-ineligible and cardiogenic shock.
16
Adapted by: Kamelia Emamian M.D. and Thao Huynh, MD, MSC.
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.