ACS Slides 1 INTRO TO CODE BLUE ACS Anti-anginal O2, - PowerPoint PPT Presentation

INTRO TO CODE BLUE ACS Slides 1

INTRO TO CODE BLUE ACS ① Anti-anginal § O2, nitroglycerin, morphine ① Anti-platelet § 1 st : ASA (162mg PO chewable) § 2 nd : P2Y 12 inhibitor (clopidogrel, ticagrelor, or prasurgrel– not if hx stroke/TIA) § 3 rd : glycoprotein IIb/IIIainhibitor (consider at PCI) ② Anti-coagulation § If fibrinolytics: UFH, LMWH, or fondaparinux § If PCI: UFH, bivalirudin, or UFH+bivalirudin ③ Revascularization § Fibrinolytics (TNK), PCI, or CABG ④ Risk factor reduction § Beta-blocker, ACEi/ARB, and Statin § Aldo antagonist (e.g. eplerenone): on BB/ACEi, either sx HF or DM, and EF<40% § Quit smoking 2

INTRO TO CODE BLUE ACS DOSES FOR SELECT MEDS Drug Load Maintenance Duration ASA 160mg PO 81mg/day Lifelong Clopidogrel 600mg pre-PCI 75mg/day 1 year 300mg lytics <24h 75mg > age 75 Ticagrelor* 180mg 90mg BID 1 year Heparin IV bolus weight IV infusion 48h or until based (load for STEMI only) (Goal 1.5-2x PTT) revascularization LMWH IV bolus weight SC injections Up to 8 days or until based (load for STEMI only) revascularization ACEi - - Lifelong Beta-blocker - - 3 years Statin - - Lifelong *Ticagreloras first line for 2 nd antiplatelet, except if lysis for STEMI—use clopidogrel 3