Dyspepsia or other gastrointestinal symptoms with longterm ASA therapy (i.e., ASA intolerance) does not usually preclude therapy in the short term.
There is evidence, however, that routine monitoring of antiplatelet effects with adjustment of the dose is a clinically effective strategy.
So-called ASA resistance may occur during chronic therapy with 2% to 8% of patients exhibiting adequate antiplatelet effect
None of the above
The risk for bleeding was especially high in elderly adults (≥75 years of age) however prasugrel no change in patients wwith reduced body weight (<60 kg, 132 lb).
Prasugrel is a prodrug like clopidogrel, and its active metabolite is reversible inhibitor of the platelet P2Y12 receptor with half life of 12 hours.
The FDA recommended the use of usual dose for ASA in combination with Ticagrelor and can be discontinued 7 days prior to CABG
Based on the totality of the evidence, a strategy of routine administration of GP IIb/IIIa inhibitors to patients with NSTE-ACS who receive DAPT with ASA and a P2Y12 inhibitor (i.e., triple antiplatelet therapy) is not recommended.
Tirofiban and Abciximab,have short half-lives (≈2 hours), with restoration of platelet function in about 4 hours; thus they should be discontinued 2 to 4 hours before major surgery
The benefit of GP IIb/IIIa inhibition appears to be greater when used in high-risk patients with STEMI-ACS than NSTEMI-ACS, such as those with ST-segment changes and/or elevated troponin concentration or diabetes
Abciximab, eptifibatide; and tirofiban are administered as an intravenous bolus followed by continuous infusion except for abciximab which has oral preparation
In patients with renal dysfunction, if the creatinine clearance is lower than 30 mL/min whether managed with hemodialysis or not, the infusion rate should be reduced to 1 mg/kg/hr.
If started during the procedure, a 0.1-mg/kg bolus dose of bivalirudin should be administered, followed by an infusion at 0.25 mg/kg/hr during PCI
In patients with NSTE-ACS before angiography, the recommended dose of bivalirudin is a 0.1-mg/kg intravenous bolus followed by an infusion at 0.25 mg/kg/hr
B. Approximately 1 mg of protamine is required to neutralize 100 units of UFH
C. Daily monitoring of the anticoagulant response via the activated partial thromboplastin time (APTT) is recommended, with titrations being made according to a standardized nomogram to achieve an APTT of 50 to 70 seconds or 1.5 to 2.5 times control
D. ALL of the above
A. Based on the data available, the ACC/AHA guidelines recommend a weight-adjusted dose of UFH (60-unit/kg bolus and 12-unit/kg/hr infusion), as well as frequent monitoring of the APTT (every 6 hours until the target range is reached and every 12 to 24 hours thereafter) and adjustment of the dose if necessary
Its greater anti–factor Xa activity (relative to factor IIa) inhibits thrombin generation more effectively
LMWH binds more avidly to plasma proteins than UFH does and therefore has a more consistent anticoagulant effect
Induces greater release of tissue factor pathway inhibitor than UFH does, and it is not neutralized by platelet factor 4
High and consistent bioavailability of LMWH
Recommended in patients with NSTE-ACS who have ST-segment changes and/or positive troponin on admission or in whom these high-risk features develop over the subsequent 48 hours
high-risk patients such as those with continuing ischemia despite intensive medical therapy, as well as in patients with acute heart failure and ventricular tachyarrhythmias
patients with NSTE-ACS previously treated with CABG and in patients who have had NSTE-ACS within 3 months of a previous PCI and in whom restenosis may be the cause
In PROVE IT-TIMI 22 trial, benefits began to emerge only 2 weeks after random assignment thus highlighting the importance of early initiation of intensive statin therapy after ACS
Of note, no adverse effects of ultra-low LDL (below 40 to 50 mg/dL) have emerged and thus statin doses should not be routinely titrated downward in asymptomatic patients who are tolerating high-dose statins after ACS
the National Cholesterol Education Program (NCEP) recommended an optional therapeutic LDL goal of less than 70 mg/dL in high-risk patients with CHD, such as those with a history of an ACS
All of the above
0.75-mg/kg bolus dose followed by an infusion at 1.75 mg/kg/hr during PCI
85 units/kg with concomitant GP IIb/IIIa inhibitor and 60 units/kg with no concomitant GP IIb/IIIa inhibitor
85 units/kg with no concomitant GP IIb/IIIa inhibitor and 60 units/kg with concomitant GP IIb/IIIa inhibitor
1.75-mg/kg bolus dose followed by an infusion at 0.75 mg/kg/hr during PCI
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