Category: ACS

 

 

Document available here.

Recommendations relevant to emergency medicine:

1. GP IIb/IIIa receptor antagonists (abciximab/reopro or eptifibatide/integrilin) can wait for the cath lab.

2. 300 to 600 mg oral clopidogrel as soon as possible is a class I recommendation. Prasugrel is the new, more expensive clopidogrel.

3. Unfractionated heparin, LMWH, fondaparinux, and bivalirudin are all acceptable anticoagulants. If patients are waiting around and PTT is subtherapeutic, rebolus unfractionated heparin.

4. Transfer thrombolysis patients to a PCI center after giving the lytic and “considering” a “preparatory” anticoagulant and antiplatelet.

5. Keep serum glucose below 180.

6. NSTEMI/UA patients going to the cath lab should get aspirin and clopidogrel (or prasugrel).

1. ACS

2. Pulmonary embolism

3. ESRD

4. Myopericarditis

5. Stanford A dissection

6. Acute heart failure

7. Strenuous exercise

8. Cardiac toxins

9. Ablation therapy / cardioversion / defibrillation

10. Cardiac infiltrative disorders (sarcoid, amyloid)

11. Heart transplant (+trop can last 3 months)

12. Cardiac contusion after blunt chest trauma

13. Sepsis / critical illness

14. Rhabdomyolysis

Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated
troponins. Heart 2006;92:987-993.