Symptoms And Treatment Of Acute Coronary Syndrome

Warfarin is used most often for long-term prophylaxis of thrombosis. “Specific indications are (1) prevention of venous thrombosis and associated pulmonary embolism, (2) prevention of thromboembolism in patients with prosthetic heart valves, and (3) prevention of thrombosis during atrial fibrillation.”(Lehne, 2010, p. 605). Warfarin is the oral anticoagulant of choice for these indications. The drug has also been used to reduce the risk of recurrent transient ischemic attacks (TIA) and recurrent myocardial infarction (MI).(Lehne, 2010).

A non-ST elevation acute coronary syndrome (NSTE-ACS) is a very common presentation to emergency departments everywhere, as well as primary care practices. Therefore, it is important that all providers be well informed on the effectivity of certain treatment regimens.

The dabigatran etexilate (DE) is a prodrug that directly competes for the active site of thrombin.1 This direct inhibition inactivates both fibrin-bound and free form of thrombin. Because of its rapid onset and offset of action, there is no need for the initial parenteral anticoagulant treatment in patients with acute thrombosis.1 On the other hand, the enoxaparin indirectly inhibits factor Xa.2 It has a shorter duration of action (12h vs 24h) and a shorter half-life (4.5-7h vs 12-14h) in comparison to DE. The DE and the enoxaparin have no interaction with diet and alcohol. There is no routine monitoring required

However, 32 patients (42.1%) were using Warfarin prior to Dabigatran. The prior use of Warfarin was significantly associated with bleeding (p= 0.014), hospitalization (p< 0.001) , and death (p= 0.007). This was more prominent in older patients > 75 years, and in patients with comorbid conditions. The rate of hospitalization in the cohort for fifty one patients was (67.1%). There were no significant associations between hospitalization, and the tested variables. The levels of hemoglobin (taken as mean of 3 values) ≥130 versus 65 years. The causes of death in patients using Dabigatran were not relevant to the drug as per the death certificates (p <0.611), [Table 3]. The reported causes of death were attributed to TE, cardiac, and respiratory arrests. The only variables that were significantly associated with death were TE [p= 0.024, (95% CI for B= 0.44 - 0.586)], and blood transfusion [p= 0.011, (95% CI for B=0.085 - 0.639];

It is mainly as a result of one of these three problems: ST elevation myocardial infarction, unstable angina and lastly non ST elevation myocardial infarction with chest pain being the main symptom (Linton, 2012). There are five main pathophysiologic processes that contribute to the development of ACS: thrombus on pre-existing plaque, active obstruction from coronary spasm, progressive mechanical obstruction, infection and unstable angina due to oxygen supply to myocardial (Linton, 2012). ACS is mainly caused by thrombus formation on a pre-existing plaque and it can be demonstrated through angiography or autopsies (Marshall, 2010). A thrombus is formed from plasma coagulation and platelets. There are risk factors that contribute to ACS such as cigarette smoking, diabetes, hypertension and high blood cholesterol (Linton, 2012). Both men and women are at a risk of having a heart attack. However it is more common in men especially when having a family background of heart attack, being overweight and inactive (Scruth, Carter, Cheng, Rolley, & Page, 2012). Modifying and identifying the risk factors is important as it can prevent further heart problems.

As the proportions of the aging U.S. population increases, more people are susceptible to venous thromboembolism (VTE) that often contribute to prolonged hospitalization, health complications, disability, poor quality of life, and premature death. This increase in VTE-related deaths and health complications has threatened the health and the economy of the U.S. society. Health care professionals need to make a better decision in preventing VTE, especially with the rise of new oral anticoagulants. Therefore, this integrative review discusses the effectiveness of Rivaroxaban, a new oral anticoagulant, versus Enoxaparin, a standard therapy, in preventing the occurrence of VTE thus reducing the nation’s

Representatives from Thrombolysis in Myocardial Infarction (TIMI), Duke Clinical Research Institute (DCRI), and Merck & Co., Inc.

D.L., a 33 year old female with history of Coronary Artery Disease was admitted with complaints of chest pain. The patient had Percutaneous Transluminal Coronary Angioplasty or PCTA in 2011. The chest pain started 3 days ago upon admission and described the pain as 3 out of 10 in pain scale for severity. The patient stated that the pain feels like a squeezing pain on the chest and no aggravating factors caused it as she recalls. The patient used Nitroglycerine to alleviate the pain, which lasted about 4 hours each past several days. The patient also stated that she was not sick, no fever or chills, and did not experience any nausea and vomiting.

After an acute coronary syndrome (ACS) event, patients are potentially at risk of further ischemic events for a considerable period time. These events may include unstable angina, non-ST elevation myocardial infarction (NSTEMI), acute MI (STEMI) or percutaneous coronary intervention (PCI). The use of dual anti-platelet therapy (DAPT) along with aspirin significantly lowers the risk of complications such as platelet-mediated thrombosis with ACS (Wiviott & Steg, 2015). For patients that participate in cardiac

Angina pectoris is the medical term for chest pains, and is associated with coronary heart disease. This occurs due to a blockage or the over time narrowing of of arteries that transport blood to the heart. With angina pectoris, the causes, diagnosis and treatment steps can mean the difference between life or death for an individual. The term angina

A STEMI is caused by an acute interruption of blood supply to an area of the heart that develops into full thickness cardiac muscle damage to the area that the vessel supplies blood to (Wadud, A; 2014). It is defined by having ST-segment elevation with pathological Q-wave formation and is condition under the umbrella term Acute Coronary Syndrome (ACS) (Wadud, A; 2014). The lack of oxygenation to the myocardium also causes the cardiac markers troponin T, troponin I and creatinine kinase myocardial brand (CK-MB) start to rise in the blood. Troponin rises within 4-6 hours and remains raised for up to two weeks whilst CK-MB starts to rise within 4-6 hours and returns to normal within 48-72 hours (Wadud, A; 2014). Nice guidance identifies that “nearly half of potentially salvageable myocardium is lost within 1 hour of the coronary artery being occluded and two thirds are lost within 3 hours” (NICE; 2013). The end of the 20th century showed the best way to re-perfuse and improve oxygenation was using a fibrinolytic drug however in recent years the use of Coronary Angioplasty, thrombus extraction catheters and stenting which are under the umbrella term Percutaneous Coronary Intervention (primary PCI) (NICE; 2013). The National Infarct Angioplasty Project (NIAP) interim report found that primary PCI will be feasible in a variety of geographical settings, will be most effective and cost-effective if delivered within 120-150 minutes from a patient’s initial call for

The common symptom of having coronary artery disease is having chest pain, discomfort that occurs in an area of your heart muscle that does not get enough oxygen-rich blood and heart failure. The

Warfarin is a very common used drug worldwide. Warfarin is used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a heart attack, stroke, deep vein thrombosis or pulmonary embolism. Although warfarin is commonly used, its management is very challenging. First, it has a very narrow therapeutic index- increased anticoagulant effect puts the patients at a risk of bleeding, while decreased anticoagulant effect puts them at a risk of thromboembolic disorders such as heart attack and stroke. And second, the wide variation among patients in drug response. Therefore, it needs long time to determine the adequate dosage for each patient. Complications from inappropriate warfarin dosing are among the adverse events most frequently reported to the US

Anticoagulant drugs are used to reduce and block the process of blood clotting. They differ from anti-platelet medications such as low-dose aspirin and clopidogrel.

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.