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|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: [[UFH|Ufractionated heparin (UFH)]], [[LMWH|low molecular weight heparin (LMWH)]]. [[Fondaparinux]] is not recommended in primary [[PCI]]. | ||
*Direct Thrombin Inhibitors: | *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|Urokinase (UK)]], [[tPA|tissue plasminogen activator (tPA)]] for STEMI when other pharmacologic and mechanical treatments are not successful | ||
===Mechanical Therapy=== | ===Mechanical Therapy=== | ||
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*Aspiration Catheter: (Export, Pronto) is the choice prior to the other interventions listed below | *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 | *Percutaneous Coronary Intervention (PCI): [[BMS|Bare metal]] or [[DES|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 | *Distal Protection: (Percusurge guardwire, Triactive, Spider wire, Proxis) particularly in [[SVG|saphenous vein grafts]] | ||
*Percutaneous Transluminal Coronary Angioplasty (PTCA) | *[[PTCA|Percutaneous Transluminal Coronary Angioplasty (PTCA)]] | ||
*Directional Atherectomy | *Directional [[Atherectomy]] | ||
*Transluminal Extraction Catheter (TEC) | *Transluminal Extraction Catheter (TEC) | ||
Revision as of 14:02, 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 is 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
- Directional Atherectomy
- Transluminal Extraction Catheter (TEC)
- Rheolytic Thrombectomy (Possis Angiojet)