TPA and aspirin and clopidogrel uptodate on MI

[Onigiri]

Hello Everyone,

have two quick questions:

1. Was still unclear on the timing of tpa for MI if we can't get them to a cath in 90 minutes if at the facility or 120 minutes not at the facility? Uptodate says within 12 hours is grade A? On step 2 what should I go with?

2. Online med ed, dustyn he says that for any established acute coronary events we should give them aspirin and clopidogrel is this true??? When he says acute coronary events does even include unstable angina?

Thank you!

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[Horners]

I think there’s a Uworld question that agrees with option 1 as well.
For future reference, Uworld > OME. OME is a great resource but it doesn’t stay updated like Uworld


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[Instatewaiter]

Hello Everyone,

have two quick questions:

1. Was still unclear on the timing of tpa for MI if we can't get them to a cath in 90 minutes if at the facility or 120 minutes not at the facility? Uptodate says within 12 hours is grade A? On step 2 what should I go with?

2. Online med ed, dustyn he says that for any established acute coronary events we should give them aspirin and clopidogrel is this true??? When he says acute coronary events does even include unstable angina?

Thank you!

Honestly the answer is more complex because it really should take into account ischemic time. However by guidelines, Tpa can be used within 24 hours (12 hours is a stronger rec). However, cath is preferential. If your facility cannot offer Cath and you can transfer to one that can offer cath within 120 min, that is preferential to tpa.

Yes to asa/plavix for nstemi and unstable angina. The trials included unstable angina .