troponin question...

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Specializes in Gen Med,LTC.

A few questions...My gran had a NSTEMI on Sunday, and now I find myself asking stupid questions that I know the answers to.

-What should the ideal INR be after a NSTEMI? hers is 2.0 on Warf. (she was on it when she had the MI, so I am thinking it should be higher) and they do not have her on lovenox or heparin. She has also been on Plavix.

-once you have done your initial 3 trops (we do then q8hx3) do you continue to check trop OD ?

Thanks...

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Specializes in ICU/ER/CARDIAC CATH LAB.

Not normally. 3 trops is enough to tell you if you've had an MI or not. If you suddenly develop chest pain again or there are other changes, then you repeat the trop again X 3.

Eilleen.

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A few questions...My gran had a NSTEMI on Sunday, and now I find myself asking stupid questions that I know the answers to.

-What should the ideal INR be after a NSTEMI? hers is 2.0 on Warf. (she was on it when she had the MI, so I am thinking it should be higher) and they do not have her on lovenox or heparin. She has also been on Plavix.

-once you have done your initial 3 trops (we do then q8hx3) do you continue to check trop OD ?

Thanks...

This is a stupid question but what is NSTEMI??? I could tell you my guesses but I think Ill pass. Okay I will....Non ST Elevated MI???

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Specializes in CCU/CVU/ICU.
This is a stupid question but what is NSTEMI??? I could tell you my guesses but I think Ill pass. Okay I will....Non ST Elevated MI???

NOt a stupid question at all. A Non ST-elevation MI is simply an MI that does not show ST elevation on 12-lead. These are usually 'less severe' than ST-elevation MI because in ST elevation the infarction is transmural (through the entire thickness of the heart wall/muscle). Another/interchangable terms would be NOn-Qwave -vs- Qwave MI. IN ST elevation, the EKG tracings eventually evolve and will show q-waves (thus the term) whereas NQWMI will not.

In non elevating MI's you'll see stuff like st-depression or t-wave inversion, or even hyperacute t-waves (peaked).

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Specializes in CCU/CVU/ICU.

-What should the ideal INR be after a NSTEMI? hers is 2.0 on Warf. (she was on it when she had the MI, so I am thinking it should be higher) and they do not have her on lovenox or heparin.

Thanks...

Forgot to add...in MI, it's not standard to anticoagulate someone with coumadin. In the early days of PTCA/stents people used to be given coumadin but it's not done much (at all?) these days. Aspirin and plavix are more-or-less the gold-standard. My guess is that she was on coumadin for something else (a-fib, cva, dvt,etc???).

The reason they didnt start her on lovenox or heparin (good observation by the way) is because with an INR of 2.0, she's already optimally anticoagulated. If they were to go higher it wouldn't make a difference as far as preventing MI. If the doc's were to procede with a catheterization (angiogram) they may stop coumadin and 'bridge' her with lovenox or heparin until afterwards.

It's unfortunate that she suffered MI while on coumadin, but unfortunately it happens.

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