Antithrombotic and thrombolytic therapy in patients undergoing coronary artery interventions: a review

Platelet glycoprotein receptor site blockade in coronary artery disease

The advent of platelet glycoprotein IIb/IIIa receptor blockade has been one of the most significant advances in the treatment of coronary artery disease. This group of drugs has been widely tested both in patients with acute coronary syndromes who are being medically treated, as well as patients undergoing interventional procedures. Debate as to the optimal use if these agents remains spirited. This debate rests on several factors, including 1) economic issues, as these drugs are expensive, 2) controversy over the meaning of specific endpoints, eg, in an otherwise uncomplicated coronary intervention, the meaning of creatine phosphokinase elevation post-procedure, and 3) what is the risk benefit ratio given the costs involved and the potential risks? Several questions remain. Do all patients with acute coronary syndromes need this as a part of medical therapy? Do all patients undergoing percutaneous coronary interventions need this group of agents, or are there populations of patients who do not need them? Are there differences between the agents that are clinically important? Is there a specific device-drug interaction? Continued evaluation of these questions will facilitate improving the outcome of the diverse group of patients treated for coronary artery diseases.

Is lidocaine infiltration during femoral sheath removal really necessary?

OBJECTIVES

To compare the effectiveness of intravenous morphine sulfate to intravenous morphine sulfate plus 1% lidocaine infiltration in pain management associated with femoral sheath removal, and to evaluate pain intensity and associated complications during femoral sheath removal in patients with heart disease receiving interventional treatment.

DESIGN

Descriptive, correlational, case-control study.

SETTING

Mid-metropolitan, university-affiliated, tertiary care medical center.

SAMPLE

Fifty patients with heart disease, who had no known allergies to morphine or lidocaine and who had not had an acute myocardial infarction, admitted to the cardiovascular intervention unit.

MEASURES

Vertical visual analogue scale, short-form McGill Pain Questionnaire, and demographic tool for complications.

RESULTS

No significant differences in pain intensity, sensation, affect, and total scores were found between the analgesic regimens. Six (12%) patients had vasovagal reactions develop, but no statistical differences were found between pain intensity scores and associated complications.

CONCLUSION

Morphine sulfate does appear effective in controlling pain associated with femoral sheath removal. The benefit of lidocaine infiltration during this procedure is questionable.