A patient is brought to the emergency department with complaints of chest pressure for 1 hour and ECG changes significant for an evolving myocardial infarction
The nurse understands that the best response from thrombolytic therapy with tissue plasminogen activator (tPA) occurs when it is
a. given concurrently with warfarin (Coumadin).
b. started within 4 to 6 hours of the onset of symptoms.
c. started immediately upon arrival in the emergency department.
d. administered only after confirmation of the diagnosis by coronary angiogram.
ANS: B
Thrombolytic therapy is most effective when started within 4 to 6 hours of symptom onset and preferably sooner.
Warfarin prevents the formation of new clots but has no effect on existing clots. There is no basis for administration at the same time as thrombolytic agents. An evolving myocardial infarction must be confirmed, as well as the absence of contraindications to thrombolytic therapy.
A patient should not receive tPA immediately upon arrival in the emergency department; a thorough evaluation must be done first.
A coronary angiogram is an invasive diagnostic procedure and is not required to confirm the diagnosis prior to tPA therapy.
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