Investigation, workup and patient preparation before PCI

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 4 Investigation, workup and patient preparation before PCI

PRELIMINARY INVESTIGATIONS

These are needed to allow three questions to be answered:

It is of particular importance to discover conditions that might increase the technical difficulty or risk of an invasive cardiac procedure. Some such factors can be corrected but awareness of others may lead to changes in peri-procedural drug therapy (see Therapeutics below), the information provided to the patient (see Consent below) or an ability to predict, and hopefully prevent, possible complications (see Anticipation below).

THERAPEUTICS (TABLE 4.2)

Anti-anginal drugs

Most patients with symptomatic coronary artery disease are taking regular anti-anginal medication, which can be continued until, and indeed, after the interventional procedure. Treatment with a long-acting nitrate and/or a calcium-channel blocker may actually be of benefit in the prevention of coronary artery spasm during/after the procedure. Although there is no convincing evidence that cholesterol-lowering therapy (e.g. statin drugs) specifically affects the short-term outcome of coronary interventional procedures, such treatment is an important part of the long-term management of patients with coronary artery disease and should, likewise, be continued.

TABLE 4.2 DRUG THERAPY PRIOR TO PCI

DRUG CLASS ACTION REQUIRED
Oral anti-anginal drugs Continue
Cholesterol-lowering therapy Continue
Oral anti-platelet therapy Ensure that aspirin has been taken
ADMINISTER LOADING DOSE OF CLOPIDOGREL (IF NOT ALREADY PRESCRIBED)
Warfarin Discontinue if possible
Measure INR and correct excessive anticoagulation
TAKE APPROPRIATE MEASURES TO AVOID HAEMORRHAGE AT VASCULAR ACCESS SITE
IV Heparin Continue
Measure ACT and consider reduced bolus dose
SC Low molecular-weight heparin Administer last injection >12 hours prior to PCI (if possible)
GP IIb/IIIa receptor antagonists Continue but consider the use of a reduced, weight-adjusted heparin regime
Pre-medication If necessary, use diazepam 5–20 mg orally
Antidiabetic medication See text
Other drug therapy Continue unchanged