Management of the thrombotic lesion: Difference between revisions

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==Treatment Choices==
==Treatment Choices==
===Pharmacologic Therapy===
===Pharmacologic Therapy===
'''Antiplatelet therapy:''' Aspirin, platelet glycoprotein IIb/IIIa receptor (GP IIb/IIIa) antagonists (abciximab, eptifibatide, tirofiban), ADP receptor/P2Y12 inhibitors (plavix, ticagrelor, prasugrel)
*Antiplatelet therapy: Aspirin, platelet glycoprotein IIb/IIIa receptor (GP IIb/IIIa) antagonists (abciximab, eptifibatide, tirofiban), ADP receptor/P2Y12 inhibitors (plavix, ticagrelor, prasugrel)


'''Antithrombin Therapy:''' Ufractionated heparin (UFH), low molecular weight heparin (LMWH). Fondaparinux not recommended in primary PCI.
*Antithrombin Therapy: Ufractionated heparin (UFH), low molecular weight heparin (LMWH). Fondaparinux not recommended in primary PCI.


'''Direct Thrombin Inhibitors:''' hirudin, bivalirudin, argatroban
*Direct Thrombin Inhibitors: hirudin, bivalirudin, argatroban


'''Thrombolytic Therapy:''' Urokinase (UK), tissue plasminogen activator (tPA) for STEMI when other pharmacologic and mechanical treatments are not successful
*Thrombolytic Therapy: Urokinase (UK), tissue plasminogen activator (tPA) for STEMI when other pharmacologic and mechanical treatments are not successful


===Mechanical Therapy===
===Mechanical Therapy===
'''Aspiration Catheter:''' (Export, Pronto) is the choice prior to the other interventions listed below 


'''Percutaneous Coronary Intervention (PCI):''' Bare metal or drug-eluting stent particularly direct stenting without pre-dilation by conventional balloon angioplasty
*Aspiration Catheter: (Export, Pronto) is the choice prior to the other interventions listed below 


'''Distal Protection:''' (Percusurge guardwire, Triactive, Spider wire, Proxis) particularly in saphenous vein grafts
*Percutaneous Coronary Intervention (PCI): Bare metal or drug-eluting stent particularly direct stenting without pre-dilation by conventional balloon angioplasty


'''Percutaneous Transluminal Coronary Angioplasty (PTCA)'''
*Distal Protection: (Percusurge guardwire, Triactive, Spider wire, Proxis) particularly in saphenous vein grafts


'''Directional Atherectomy'''.
*Percutaneous Transluminal Coronary Angioplasty (PTCA)


'''Transluminal Extraction Catheter (TEC)'''
*Directional Atherectomy


'''Rheolytic Thrombectomy (Possis Angiojet)'''
*Transluminal Extraction Catheter (TEC)
 
*Rheolytic Thrombectomy (Possis Angiojet)


{{SIB}}
{{SIB}}

Revision as of 13:45, 6 August 2010

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief:

Goals of Treatment

There are several main goals in treating thrombotic lesions, including:

  • Reperfusion of the epicardial artery and the downstream microvasculature
  • Resolution/reduction of [[thrombus burden
  • Avoid/minimize distal embolization
  • Avoid/reduce thrombotic major adverse cardiac events (death, MI, recurrent ischemia, urgent target vessel revascularization (TVR))

Treatment Choices

Pharmacologic Therapy

  • Antiplatelet therapy: Aspirin, platelet glycoprotein IIb/IIIa receptor (GP IIb/IIIa) antagonists (abciximab, eptifibatide, tirofiban), ADP receptor/P2Y12 inhibitors (plavix, ticagrelor, prasugrel)
  • Antithrombin Therapy: Ufractionated heparin (UFH), low molecular weight heparin (LMWH). Fondaparinux not recommended in primary PCI.
  • Direct Thrombin Inhibitors: hirudin, bivalirudin, argatroban
  • Thrombolytic Therapy: Urokinase (UK), tissue plasminogen activator (tPA) for STEMI when other pharmacologic and mechanical treatments are not successful

Mechanical Therapy

  • Aspiration Catheter: (Export, Pronto) is the choice prior to the other interventions listed below
  • Percutaneous Coronary Intervention (PCI): Bare metal or drug-eluting stent particularly direct stenting without pre-dilation by conventional balloon angioplasty
  • Distal Protection: (Percusurge guardwire, Triactive, Spider wire, Proxis) particularly in saphenous vein grafts
  • Percutaneous Transluminal Coronary Angioplasty (PTCA)
  • Directional Atherectomy
  • Transluminal Extraction Catheter (TEC)
  • Rheolytic Thrombectomy (Possis Angiojet)

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