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Cardiology
Vasopressors, Vasodilators, and Antithrombotics in the Catheterization Laboratory
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 102 slides
Overview
- Scope of cath-lab pharmacotherapy
- Drug groups used in the catheterization laboratory
Antithrombotic therapy
- Why antithrombotic therapy is central
- Extrinsic (tissue factor) pathway
- Thrombin and fibrin formation
- Intrinsic (contact activation) pathway
- Coagulation cascade
Anticoagulants: heparin and bivalirudin
- Role of anticoagulants during PCI
- Choosing between UFH and bivalirudin
- Anticoagulant Dosing During Percutaneous Coronary Intervention
- Mechanism of unfractionated heparin
- Unfractionated heparin pharmacology
- Sources of variable heparin response
- Heparin-induced thrombocytopenia
- Managing suspected heparin-induced thrombocytopenia
- Guideline positioning of the two anticoagulants
- Older trials: HORIZONS-AMI and EUROMAX
- Contemporary trials: HEAT-PPCI and VALIDATE-SWEDEHEART
- BRIGHT-4 and the unresolved bleeding question
- Comparative Efficacy and Safety of Unfractionated Heparin and Bivalirudin in Primary Percutaneous Coronary Intervention: trials and P2Y12 loading
- Comparative Efficacy and Safety of Unfractionated Heparin and Bivalirudin in Primary Percutaneous Coronary Intervention: treatment regimens
- Comparative Efficacy and Safety of Unfractionated Heparin and Bivalirudin in Primary Percutaneous Coronary Intervention: outcomes
- Mechanism of Action and Pharmacokinetic Parameters of Intravenous Antithrombotic Medications
- Activated clotting time monitoring
- Limitations of activated clotting time targets
- Enoxaparin in non-ST-elevation ACS
- Enoxaparin monitoring and pharmacokinetics
Anticoagulation with mechanical support
- Positions of percutaneous mechanical support devices
- Anticoagulation strategies by device
- The Impella purge solution
- Bicarbonate-based purge solution
- Monitoring anticoagulation during Impella support
- Anticoagulation during ECMO
- Monitoring anticoagulation during ECMO
Antiplatelet therapy
- Stent deployment in a coronary artery
- Rationale for dual antiplatelet therapy
- Agents used for platelet inhibition
- Intravenous and Oral Antiplatelet Dosing
- Intravenous and Oral Antiplatelet Dosing (continued)
- The CURE trial
- Variability of clopidogrel response
- Proton pump inhibitor interaction
- TRITON-TIMI 38
- Prasugrel: populations to avoid
- The PLATO trial
- Ticagrelor: pharmacology and adverse effects
- ISAR-REACT 5
- Criticisms of ISAR-REACT 5
- Comparative Efficacy and Safety of Oral P2Y12 Inhibitors
- Guideline choice of P2Y12 inhibitor
- Switching between P2Y12 inhibitors
- Timing of P2Y12 inhibitor initiation
- Cangrelor in the catheterization laboratory
- Duration of dual antiplatelet therapy
- Recommended DAPT durations
Dual versus triple antithrombotic therapy
- The triple therapy problem
- The WOEST trial
- Direct oral anticoagulant trials
- Current approach to combined therapy
- Documenting risk at the time of PCI
Haemodynamic support
- Principles of vasoactive drug selection
- Summary of Inotrope and Vasopressor Dosing and Pharmacology
- Dobutamine versus milrinone: pharmacokinetics
- Milrinone: mechanism and haemodynamic profile
- The DOREMI trial
- DOREMI subgroup by renal function
- Norepinephrine as first-line vasopressor
- Epinephrine versus norepinephrine: OptimaCC
- Dopamine and the SOAP II trial
- Matching the agent to the clinical presentation
- Clinical Trial Summary of Inotropes and/or Vasopressors in Cardiogenic Shock: design
- Clinical Trial Summary of Inotropes and/or Vasopressors in Cardiogenic Shock: results
- Mechanical circulatory support versus drugs
- Early mechanical support in infarct-related shock
Intracoronary and intra-arterial medications
- Occluded coronary arteries on angiography
- Indications for intracoronary drug administration
- Management of coronary no-reflow
- Intracoronary Medications for Coronary No-Reflow
- Intracoronary epinephrine for refractory no-reflow
- Intracoronary antithrombotic agents
- Catheter route for coronary angiography
- Preventing radial artery occlusion
- Intra-arterial spasmolytic dosing
Summary
- Antithrombotic therapy: key points
- Haemodynamic and intracoronary therapy: key points
- Conclusions
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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