**26. Anticoagulant treatment**

monitored. In patients who develop complications, plasminogen or fibrinogen levels in the

In adult cases, following a 15 mg iv bolus dose, 0.75 mg/kg/hr. is administered in 30 mins. The success of fibrinolytic treatment is evaluated with the correction of ST elevation and the

As Paediatric MI cases are emergencies and the condition is urgent and life-threatening, it may be more appropriate to administer intra-coronary or iv high-dose bolus treatment fol-

Unlike alteplase, there is no need for an infusion following the administration of IV bolus. To open blocked catheters in Paediatric patients, 0.1 units was administered and in cases where no response could be obtained, increases were applied of 0.1 units up to a maximum of 0.4 units. Successful results have been obtained with this treatment [85]. In adult coronary thrombo-embolic cases, it is recommended that 10 units are given in the form of 2 doses at a

This is a drug given in bolus form to myocardial infarction patients after diagnosis [23]. Unlike other tissue plasminogen activators, it is a time-saving application as there is no requirement for repeated bolus doses. The recommended doses for adults are 30 mg (6000 unit) for patients <60 kg in weight, 35 mg for those weighing 60–70 kg, and 40 mg for those of 70–80 kg [23].

Streptokinase has been used for many years in adult MI patients. Experience related to the efficacy of streptokinase in PMI has been acquired from Kawasaki patients in particular. Studies have shown that in Kawasaki patients with MI, the use of intravenous or intra-coronary streptokinase followed by heparinisation and warfarin or dipyridamol in maintenance, is effective [87, 88]. If Percutaneous Coronary Intervention (PCI) is not applied within the first 2 hours after diagnosis in cases with MI, immediate thrombolytic treatment should be applied with a half-hour infusion. Fibrinolytic treatment can be administered to patients diagnosed

In adult patients, it is recommended that PCI is applied within 2 hours of MI diagnosis. In patients where it is predicted that the time from diagnosis to PCI will exceed 2 hours, it is recommended that fibrinolytic treatment is given first in bolus form, after that fibrinolytic

blood are examined, and if necessary the treatment must be stopped.

patient symptoms [23].

**24.2. Reteplase**

120 Myocardial Infarction

30-min interval [23].

**24.3. Tenecteplase**

**24.4. Streptokinase**

with MI within the first 12 hours of diagnosis [23].

**25. Percutaneous coronary intervention**

treatment catheter unit intake for PCI [23].

lowed by 0.1–0.5 mg/kg /hr. infusion.

Anticoagulation is recommended for all patients in addition to antiplatelet therapy during primary PCI [23]. The most commonly used drug for this is unfractioned heparin. The initial dose is given in bolus form as 70–100 units/kg and in maintenance, it can be given according to the active clotting time or as 10–15 units/kg/hr. After admission to hospital, it can be terminated within 8 hours of clearance of the coronary occlusion or it can be continued intra venously for 24–48 hrs to heparinisation. The goal is an aPTT value of 50–70 seconds or 1.5–2 fold the control value. It is recommended that the test is repeated at 3, 6, 12 and 24 hours [23].
