ANTITHROMBOTIC

MANAGEMENT IN PCI
BY
HASBI ASH SHIDDIEQ, S.Kep.,Ners
 INTRODUCTION
Percutaneous Coronary Intervention (PCI) disrupts the
coronary endothelium, leading to the exposure of
subendothelial tissue factors to blood. Intracoronary
thrombosis may result during or soon after the procedure. In
addition, metal stents can trigger thrombus formation. Stent
thrombosis can be a life-threatening event
 Antithrombotic Agents

Platelet
Inhibitors Anticoagulants

Fibrinolytics
PLATELET INHIBITORS
ANTICOAGULANTS
 FIBRINOLYTICS
• It is often mistakenly believed that the purpose of anticoagulants such
as heparin or warfarin is to digest and remove pre-existing clots, but
this is not the case. A totally different class of drugs, the thrombolytics,
is needed for this purpose.
• Thrombolytics promote the process of fibrinolysis, or clot destruction,
by converting plasminogen to plasmin. The enzyme plasmin digests
fibrin and breaks it down into small soluble fragments. Unlike the
anticoagulants that can only prevent clots, thrombolytics actually
dissolve the insoluble fibrin within the clot
 ANTIPLATELET THERAPY IN PCI

• Aspirin therapy should be given 80 mg at least 5 days before PCI.

• After PCI, aspirin should be continued at 80 mg/day indefinitely.
• Clopidogrel therapy should be given 75 mg at least 5 days before
PCI
• After PCI, clopidogrel should be continued at 75 mg/day at least
6 month
ANTICOAGULANTS THERAPY IN PCI

• In patients undergoing PCI, it is standard practice to give

heparin, commencing with either an IV bolus of 10 000 U
or a weight-adjusted dose regimen of 100 to 175 U/kg
• Postprocedural heparin infusions are not needed for most
patients who are treated with a combination of aspirin and
clopidogrel after PCI
 NURSING PROCESS FOCUS
qObtain a complete health history of cardiovascular, a drug history
including allergies
qObtain baseline weight, vital signs, ECG (if appropriate), and breath
sounds.
qAssess for presence, quality, location of angina, and for presence of
dyspnea or chest pain.
qEvaluate appropriate laboratory findings (e.g., aPTT, PT, or INR),
complete blood count (CBC), renal and liver function studies
qMonitor for signs and symptoms of increased or excessive visible
bleeding and for occult bleeding
qContinue to monitor frequent labs (ACT, aPTT, PT, or INR), CBC,
and platelets