Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
- Skeletal or Cardiac Muscle Injury
- Onset: 4-8 Hours
- Peak: 12-24 Hours
- Return to Normal: 2-3 Days
Cardiac Enzyme Evaluation: Myoglobin
- Skeletal or Cardiac Muscle Injury
- Onset: 1 - 4 Hours
- Peak: 12 Hours
- Return to Normal: 24 Hours
- Elevation After 24 Hours: Reinfarction
Cardiac Enzyme Evaluation: Troponin
- Cardiac Muscle Injury
- Detection in Blood: 4 Hours
- Peak: 24 - 36 Hours
- Return to Normal: 5 - 14 Days
- Most Specific for Cardiac Muscle
- Treat Aggressively
Abciximab and Tirofiban (GP IIb/IIIa Inhibitors)
- IIb/IIIa Receptor Inhibitors
- Inhibits Platelet Aggregation
- Thrombotic Event Prevention
- Acute Coronary Syndrome (ACS)
- Percutaneous Coronary Intervention (PCI)
- Bleeding
- Expensive
- Combination Drug Therapy
Heparin Indications
- Acute Coronary Syndrome (ACS)
- Prophylaxis
- Pulmonary Embolism
- Atrial Fibrillation
- Used during Pregnancy
Heparin Induced Thrombocytopenia (HIT)
- 5-10 Days After Heparin Exposure
- Heparin-Platelet Factor 4 Complex
- Autoantibodies Form Against Complex
- Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
- Platelet Aggregation
- Procoagulant Release
- Thrombocytopenia
- Serotonin Release Assay (SRA)
- Stop Heparin, Start Direct Thrombin Inhibitor
Heparin Mechanisms
- Short Half-life
- Antithrombin Activation Cofactor
- Decrease Thrombin, Factor Xa
- Bleeding
- Heparin Induced Thrombocytopenia (HIT)
- Protamine Sulfate
Enoxaparin (Lovenox)
- Inhibits Clotting Factors
- Factor Xa
- Clot Formation Prevention
- Heparin Induced Thrombocytopenia (HIT)
- Bleeding
- Medication Education
- Subcutaneous Injection
- 2 Inches from Umbilicus or Incisions
- Protamine Sulfate