Sorafenib For the Beginners

Neither prasugrel nor ticagrelor should be used after previous haemorrhagic stroke and in liver disease. When these agents are not available or if contraindicated, clopidogrel 600?mg should be given, followed by 150?mg maintenance dose in the first week and 75?mg thereafter. Anticoagulants UBE3A for primary PCI include UFH, enoxaparin or bivalirudin. UFH iv. bolus should be 70�C100?U/kg when no GPIIb/IIIa inhibitor is planned. There are no solid data to recommend the use of ACT to tailor UFH dose. When enoxaparin is used, iv. bolus 0.5?mg/kg should be followed by s.c. treatment. Based on the ATOLL trial and on the considerable clinical experience with enoxaparin in other PCI settings, enoxaparin may be preferred over UFH. One trial demonstrated the superiority of bivalirudin over the combination of UFH+GP IIb/IIIa inhibitor, a benefit driven by a marked reduction in bleeding, associated with an initial increase in stent thrombosis. Trials performed before the DAPT era documented benefits of GPIIb/IIIa inhibitors during primary PCI. The FINESSE trial found that routine upstream abciximab before primary PCI did not yield clinical benefit but increased bleeding risk. The BRAVE-3 trial did not show benefit from abciximab in primary PCI among patients pre-treated with Trichostatin A nmr 600?mg of clopidogrel. Therefore, the current role of routine GPIIb/IIIa inhibitors in primary PCI in the era of potent DAPT is questionable. Bailout use of GPIIb/IIIa inhibitors with angiographic evidence of large thrombus, slow or no-reflow and other thrombotic complications is reasonable. The AIDA-4 trial found no clinical benefit (but also no harm) with intracoronary route of administration. Therefore, the iv. route remains the standard of care for administration of GPIIb/IIIa inhibitors. Routine post-procedural anticoagulant therapy is not indicated after primary PCI except when there is a separate indication for either full-dose anticoagulation due to, for instance, atrial fibrillation, mechanical valves, LV thrombus, or prophylactic doses for prevention of venous thromboembolism in patients requiring prolonged bed rest. Inadequate myocardial Sorafenib nmr perfusion after successful opening of the infarct related artery is referred to as ��no-reflow��. The diagnosis of no-reflow: post-procedural TIMI flow