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COntoh Kasus Fibrinolytic Agents
COntoh Kasus Fibrinolytic Agents
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stimulation.
When:
Class I: Administer oral beta blocker therapy within the first 24 hours for patients who do not have 1 or more of the
following: (1) Signs of heart failure, (2) evidence of a lowoutput state, (3) increased risk of cardiogenic shock,b or (4)
other relative contraindications (PR interval > 0.24 seconds, second or thirddegree heart block, active asthma or
reactive airway disease).
Class IIa: Administer beta blockers IV at time of presentation for hypertension if none of the following are present: (1)
Signs of heart failure, (2) evidence of a lowoutput state, (3) increased risk of cardiogenic shock, * or (4) other relative
contraindications (PR interval > 0.24 seconds, second or thirddegree heart block, active asthma, or reactive airway
disease)
Metoprolol: 25 to 50 mg PO or 5 mg IV slow push every 5 minutes for 3 doses (do not repeat the IV dose if the heart
rate falls to < 60 bpm or BP to < 100 mm Hg). Begin the oral doses 15 minutes after the last IV dose at 50 mg PO four
times per day for the first 24 hours and then 100 mg twice per day.1
Watch Out:
Beta blockers are contraindicated in patients with the following conditions: CHF; pulmonary edema; history of
significant bronchospasm or asthma; systolic BP < 100, or signs and symptoms of hypoperfusion; severe COPD;
second or thirddegree heart block; or severe peripheral vascular disease.
Relative contraindications include sinus bradycardia with heart rates < 60, firstdegree AV block (especially if PR
interval is > 0.24 seconds), and insulindependent diabetes
Fibrinolytic Agents
Reperfusion therapy may consist of the use of a fibrinolytic agent or PTCA. Most hospitals cannot perform emergency
PTCA or cannot perform PTCA within the recommended time intervals. Therefore, patients who qualify for reperfusion
therapy are often treated with the rapid use of fibrinolytic agents.
Indications for fibrinolytic therapy19,56 :
Class I: For patients younger than 75 years with no contraindication to the use of fibrinolytic agents, fibrinolytic IV
therapy. This holds true if the patient's complaints are consistent with ischemic coronary pain, the ECG shows ST
elevation > 1 mm in at least 2 anatomically contiguous leads, or the patient has developed a new LBBB and there is
strong suspicion for acute MI. Administer the fibrinolytic agent within 12 hours of onset of pain.
Class IIa: For patients older than 75 years who meet the above criteria, the risk of the use of fibrinolytic
agents increases but use is considered a Class IIa treatment; use within 12 hours of the onset of pain.
Class IIb: Fibrinolytic IV therapy is considered a Class IIb intervention for patients who are seen after 12 hours
of the onset of their symptoms but still have pain and ST elevation.14 In this setting it is assumed that
myocardial cells are still infarcting.
Class III: Fibrinolytic therapy offers no benefit to patients presenting with ACS not accompanied by ST
segment elevation. The TIMIIIIB study,60 which is the major study addressing the use of fibrinolytics in the
treatment of ACS not accompanied by STsegment elevation, showed no advantage to using tPA in this group
and suggested a strong trend toward an increase in intracranial bleeding.
Choosing the Correct Fibrinolytic Agent
Currently approved fibrinolytic agents:
https://calsprogram.org/manual/volume3/section12/CV/12‐CV11AcuteCorSyndrome13.html 11/22