Tabel nr.

5
Tratament adjuvant
Tratamentul conservator al NSTEMI / AI reperfuziei
coronariene-STEMI
1. Tratament antiischemic
Analgezie o O2-2-3l/min (max.6l/min-in debit mai mare provoaca idem
vasoconstrictie) [1]
o Morfina : 2,5-5 mg iv + 10 mg Metoclopramid iv [2]
( CI: TAS < 100 mmHg ) [3]
Nitrati o NTG : - 0,5 mg la 5-10min(maxim x3) sublingual; [1]
- Spray 1-2puffuri repetate la 3-5min(max.3); [2]
- 5-10µg/min,poate fi crescut cu 5-20µg/min idem
titrat in functie de durere [1]
ATENTIE : mentinerea TAS ≥100 mmHg [2]
CI absoluta : ingestie de Sildenafil (Viagra) in ultimile 24h [2]

Β blocanti o Metoprolol : - 12,5-100 mg p.o. ( x 2 /zi) [2]

- 1-2 mg iv repetat la 1-2 min, max 15-20 mg [4]
ATENTIE : valori tinta AV=60/min, TAS=100-110 mmHg [5]
CI absolute : - AV<60/min ; TAS<100mmHg
- tulburari de conducere – BAV idem
- afectiuni pulmonare severe
- IC moderata/ severa
CI relative : - astm bronsic
- tratament cronic cu β blocante / blocante de Ca
- boli vasculare periferice severe
- IM inferior + VD
Blocante de Ca o Diltiazem 60-360 mg p.o. – adjuvant pt Nitrati,Βeta-
blocanti si Blocante de Ca; NU in terapie unica [2]
o Verapamil 40-120 mg p.o. – adjuvant pt Nitrati,Βeta- Nu se administreaza
blocanti si Blocante de Ca; NU in terapie unica
o Amlodipine 5-10 mg p.o.
- indicatii : IVS / EPAC
Statine o Atorvastatina 80 mg p.o. [2] idem
Inhibitori ai enzimei Nedocumentata utilizarea precoce in NSTEMI / AI [2] recomandat dupa
de conversie tratament de
reperfuzie
2. Tratament antiplachetar
Aspirina -162-325mg p.o initial, apoi 75-162mg/zi permanent [6] idem
CI : alergie sau intoleranta gastrica majora [2]
Plavix - 75 mg p.o. (continuat minim 1 luna – pana la 9 luni) [7] -75mg la pac >75 ani
Clopidogrel -300mg la pac<75ani
-75mg pt 1 an
[1]
Inhibitori IIb / IIIa o Eptifibatida -180 μg/kg bolus apoi 2 μg/kg/min(injumatatirea
(asociate Aspirinei, dozei pt clerance al creatininei < 50ml/min)
Plavixului si o Tirofibanul – 400ng/kg/min in 30 min apoi 100 idem
Heparinei) ng/kg/min(injumatatirea dozei pt clerance al creatininei <
30ml/min)
Indicatie relativa: pacientii cu clasa de risc inalt care fac
angiografie per primam.
o Abciximab- nu se administreaza [6]

3. Tratament antitrombotic
Heparine cu greutate o Enoxaparin 30mg iv bolus, 1 mg/kgc la 12h s.c. - <75ani bolus 30mg
moleculara mica (pt.clerance al creatininei<30ml/min, se adm.doza iv,apoi 1mg/kgc sc
unica 1mg/kgc) la12h [8]
->75ani 0,75mg/kgc
o Dalteparin120 u/kgc x 2/zi s.c. , max.10000 UI la sc
12h [6], [8]
Heparina 60-70 u/kgc (max 4000 u) bolus iv, apoi 12 u/kgc/h, max
(asociata Aspirinei si 1000u/h idem
Plavixului) APTT tinta : 1,5/2 x valoarea normala (la 6 si 24h) [6], [8]

[1] - Gabriel Tatu Chitoiu, Maria Dorobantu, Anton Petris, Dan Deleanu, Raed Arafat, Bogdan Oprita, et. al.
Ghid de tratament in faza pre-spital al infarctului miocardic acut cu supradenivelare de segment ST. Revista
Romana de Cardiologie, vol. XXIII, nr.3, 2008, pag. 245-246.
[2] - Oxford Handbook of Acute Medicine, Oxford University Press, 2004, reprinted 2005, pag. 56.
[3] - Maria Dorobantu. "Boala Coronariana Ischemica (Angina Stabila, Sindrom Coronarian Acut)",
Compendiu de Boli Cardiovasculare, sub Red. Maria Dorobantu, Editura Universitara "Carol Davila". 2004.
Capitol 11,pag. 290
[4] - The Washington Manual of Medical Therapeutics 32nd edition, Lippincot Williams & Wilkins 2007 by
Departement of Medicine, Washington University School of Medicine, pag. 56.
[5] - Oxford Handbook of Acute Medicine, Oxford University Press, 2004, reprinted 2005, pag. 18.
[6] - American College of Cardiology Foundation / American Heart Assocition Pocket Guidleine, october
2007, update 2009
[7] - Oxford Handbook of Acute Medicine, Oxford University Press, 2004, reprinted 2005, pag. 58.
[8] - Gabriel Tatu Chitoiu, Maria Dorobantu, Anton Petris, Dan Deleanu, Raed Arafat, Bogdan Oprita, et. al.
Ghid de tratament in faza pre-spital al infarctului miocardic acut cu supradenivelare de segment ST. Revista
Romana de Cardiologie, vol. XXIII, nr.3, 2008, pagina 279.