Anticoagulants, Cardiovascular
Anticoagulants are used for anticoagulation in patients with unstable angina.
Lepirudin (Refludan)
Lepirudin is a recombinant hirudin derived from yeast cells. When compared with UFH in unstable angina trials, hirudin demonstrated a modest short-term reduction in the composite endpoint of death or nonfatal MI. The risk of bleeding is modestly increased. Currently, hirudin is indicated only in patients who are unable to receive heparin because of heparin-induced thrombocytopenia.
Bivalirudin (Angiomax)
Bivalirudin is a synthetic analogue of recombinant hirudin. It inhibits thrombin and is used for anticoagulation in patients with unstable angina who are undergoing percutaneous transluminal coronary angioplasty (PTCA). With provisional use of a GPIIb/IIIa inhibitor, it is indicated for anticoagulation in patients undergoing PCI.
The potential advantages of bivalirudin therapy over conventional heparin therapy include more predictable and precise levels of anticoagulation, activity against clot-bound thrombin, absence of natural inhibitors (eg, platelet factor 4 and heparinase), and continued efficacy after clearance from plasma (because of binding to thrombin).
Argatroban
Argatroban is a selective thrombin inhibitor that inhibits thrombin formation by binding to the active thrombin site of free and fibrin-bound thrombin. It inhibits thrombin-induced platelet aggregation.
Dabigatran etexilate (Pradaxa)
Dabigatran etexilate is a selective thrombin inhibitor that inhibits thrombin formation by binding to the active thrombin site of free and fibrin-bound thrombin. It inhibits thrombin-induced platelet aggregation.
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This ECG represents a patient who came in to the emergency department with 8/10 chest pain. The patient had old right bundle-branch block (RBBB) and left ventricular hypertrophy (LVH), and this compared similarly to his previous ECGs.
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Classic Wellens syndrome T-wave changes. ECG was repeated on a patient who came in to the emergency department with 8/10 chest pain after becoming pain free secondary to medications. Notice the deep T waves in V3-V5 and slight biphasic T wave in V6 in this chest pain– free ECG. The patient had negative cardiac enzyme levels and later had a stent placed in the proximal left anterior descending (LAD) artery.
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A 57-year-old with 4/10 pressurelike chest pain. Improvement with treatment by EMS. The patient had this ECG on arrival. Notice perhaps the beginning of a small biphasic T wave in V2.
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Pain-free ECG of a 57-year-old patient who presented with 4/10 pressurelike chest pain. Notice after the patient was treated with medications and pain subsided, the ECG shows T-wave inversion in V2 and biphasic T waves in V3-V5. This more closely resembles the less common presentation of Wellens syndrome with a biphasic T-wave pattern. This patient had a cardiac catheterization that showed a subtotal occlusion of the proximal left anterior descending (LAD) artery, which was stented, and the patient did well.
