ACS Part 4 Flashcards
When is anticoagulation treatment recommended
Recommended in addition to antiplatelet therapy to improve vessel patency and prevent re-occlusion
What is the main side effect caused by unfractionated heparin?
Heparin-induced thrombocytopenia
What causes HIT?
Formation of antibodies that activate platelets
What do you do if HIT is suspected?
Calculate 4T score
What is the 4T score?
-Thrombocytopenia
-Timing
-Thrombosis
-Other causes of thrombocytopenia
What are the screening tests available if HIT is suspected?
-Enzyme-linked immunosorbent assay: quick but has a high false positivity rate
-Serotonin release assay: gold standard for diagnosis, often a “send-out” lab
Is unfractionated heparin the only anticoagulant that can cause HIT?
LMWH can too
Can a patient with a history of HIT be re-challenged with unfractionated heparin or LMWH?
No patients should not be rechallenged with either
Characteristics of UFH
-Quick onset and short half life
-Administered as a continuous infusion
-Dosing is based off of the activated partial thromboplastin time or activated clotting time
Do we routinely check anti-Xa levels for patients on enoxaparin?
No, usually not necessary and difficult to interpret results. Consider in certain cases such as very high or low body weight and renal impairment.
What is bivalirudin?
Direct thrombin inhibitor
When can bivalirudin be used together with GPIIb/IIIa inhibitors?
In bail out
When would you use fondaparinox?
-Can use in patients with a history of HIT
-Do not use alone for PCI due to high rates of thrombosis
What is fondaparinox contraindicated in?
CrCl less than 30
When can heparin be used?
-It can be used in both UA/NSTEMI and STEMI
-Use for 48 hours in ischemia guided therapy and fibrinolytics
-Use until PCI if patient is receiving PCI
