acute MI--Question about thrombolytics

[angiebaby]

I was taking care of an acute MI pt in the ER the other day. After the EKG was done, (elevated ST segments), pt was diaphoretic and nauseated. He had chest pressure pain 10/10. Our tx included nitro drip, aggrastat,tnkase,Mso4, and lovenox. When we got our pt stablelized, we transferred him to ICU. The nurses on the unit said that we should not have done aggrastat and tnkase at the same time. I asked the pharmacist, she did not find any information that determined both tx's to be contraindicated. My question is Who is right ER or ICU nurses. By the way, of course everything we did was authorized by the ER doc.

[jadednurse]

I've never given 2 thrombolytics simultaneously. My experience has been in ICU.

[debbyed]

We have several Cardiologist that now combine thrombolytics. They tell us exactally how much to give, how fast to give it and when to give it.

[debi87021]

tnkase and aggrastat work slightly differently if i remember correctly. And if the PHARMACY can not find conindications then go with the philosophy...two is better than one. How is the pt now?

[lee1]

I believe that several years ago there were studies involving Reapro and TPA/TNK that showed the combination of these 2 types of drugs very dangerous-----Aggrastat is slightly less potent

There is NO medical recommendation existing at present for what your doctor ordered unless it was under a research protocol

[CCL"Babe", BSN, RN]

Our cath lab does a fair amount of reasearch. We do not currently use Aggrastat. We do though on occasion hang Integrelin and Reopro or Integrelin and Angio max together.

[CCURN]

Aggrastat is not used as a lytic in our facility, it is used to decreased platelet aggregation, especially at the clot site. But I have never seen it used as a combo with a lytic. Our patients however usually go straight to the cath lab, but that is only if they use Heparin as both integrillin and lytics are contraindicated for angio, We usually use the following treatment protocols for acute MI.

Nitro gtt

Heparin gtt

Integrillin or Aggrastat gtt - after stenting

Lopressor 5mg IV x 3

Aspirin

Mso4

Cath

[NurseGirlKaren]

I am in the Cath lab and we do PCI. Reopro/Integrilin/Aggrastat are not thrombolytics; they make the platelets "slippery", like CCURN said. We routinely give heparin boluses during the procedure, hang Reopro or Integrilin, and if need be, do give intracoronary thrombolytic (Activase).

[kewlnurse]

We almost neve use reapro or aggrastat, always integrulin, but after TKN usually just heparin, take if for what it's worth since we aren't exactually the cutting edge of health care and about 5-10 years behind the rest of the country.