TPA & Fibrinolytics 

Transfer from Non-PCI capable Center

Goal timing for fibrinolytic administration:

• 90 minutes from first medical contact (call to needle)

• 30 minutes on arrival to the hospital (door to needle)

• Not indicated if AMI onset was >12 hours ago

Risks:

• Increased risk of hemorrhagic AND ischemic strokes within 1 day of administration (3.9 per 1000 patients treated)

• Increased risk of major life-threatening bleeds or bleeds requiring transfusions (4-13% of patients treated)

• Increased risk of re-occlusion (10% during index hospitalization, 30% within 3 months)

Choice of P2Y12 and Dose:

• ACC/AHA Guidelines: Only Clopidogrel has been robustly studied with fibrinolysis

• Dose:

  • Age ≤75: Plavix 300mg load -> 75mg Daily

  • Age >75: Plavix 75mg Daily without load

  • If no initial load

    • PCI ≤24 hours of lytics: Plavix 300mg load -> 75mg Daily

    • PCI >24 hours of lytics: Plavix 600mg load -> 75mg Daily

Transfer from Non-PCI capable Center