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STEMI reperfusion Time to treatment goals
Please have this information available for Cardiologist, this may impact treatment!
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III. *Relative contraindications: benefit of PCI may be > thrombolytics, particularly if multiple factors are
present. Reasonably assess combined factors.
History of chronic severe, poorly controlled hypertension
Severe hypertension on presentation (SBP >180mm Hg or DBP >110 mm Hg)
History of prior ischemic stroke > 3 months
Dementia
Known intracranial pathology not covered in absolute contraindications
Traumatic or prolonged (>10 min) CPR
Recent (within 2-4 weeks) internal bleeding
Internal bleeding within 2-4 weeks but not currently
Noncompressible vascular punctures
Pregnancy
Active peptic ulcer
Oral anticoagulant therapy
*2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
IV. If patient clearly fits criteria for thrombolytic therapy, proceed immediately! If you are not sure, prepare
for thrombolysis (mix drug) while waiting to talk to PCI Interventional Cardiologist. Continue to work on
transport options. Stable post-lytic patients may not need air transport.
Note: Choice of thrombolytic agent is site dependent. Specific instructions for your
site are placed on back of the Thrombolytics Assessment Worksheet
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ACTIVASE (Alteplase)
Remember, Time = Muscle! Door to needle goal <30 minutes!
Acute Myocardial Infarction
Administer Activase as soon as possible after the onset of symptoms.
There are two Activase dose regimens for use in the management of acute myocardial
infarction; controlled studies to compare clinical outcomes with these regimens have not
been conducted.
A DOSE OF 150 mg OF ACTIVASE SHOULD NOT BE USED FOR THE TREATMENT OF ACUTE
MYOCARDIAL INFARCTION BECAUSE IT HAS BEEN ASSOCIATED WITH AN INCREASE IN
INTRACRANIAL BLEEDING.
Accelerated Infusion
The recommended total dose is based upon patient weight, not to exceed 100 mg. For patients weighing > 67
kg, the recommended dose administered is 100 mg as a 15 mg intravenous bolus, followed by 50 mg infused
over the next 30 minutes, and then 35 mg infused over the next 60 minutes.
For patients weighing <67 kg, the recommended dose is administered as a 15 mg intravenous bolus, followed
by 0.75 mg/kg infused over the next 30 minutes not to exceed 50 mg, and then 0.50 mg/kg over the next 60
www.heart.org/HEARTORG/Affiliate/Kansas-Mission-Lifeline_UCM_454367_SubHomePage.jsp www.projectupstart.com
www.heart.org/HEARTORG/Affiliate/Kansas-Mission-Lifeline_UCM_454367_SubHomePage.jsp www.projectupstart.com