Myocardial infarction prophylaxis

Aspirin is indicated for the relief of minor aches and mild to moderate pain (325-650 mg every 4 hours), for arthritis and related arthritic conditions (3.2-6.0 g/day), to reduce the risk of transient ischemic attacks (1.3 g/day), for myocardial infarction prophylaxis (300-325 mg/day), and as a platelet aggregation inhibitor (80-325 mg per day). It is available in a large number of dosage forms and strengths as tablets, suppositories, capsules, enteric-coated tablets, and buffered tablets. 

Fondaparinux, the factor Xa-binding pentasaccharide (Arixtra, MW 1,728 Da), is prepared synthetically, unlike UFH, LMWH and danaparoid, which are obtained from animal sources. Despite only inactivating free factor Xa, clinical trials indicate that fondaparinux is an effective antithrombotic agent, both for venous thromboembolism prophylaxis and treatment, as well as for acute coronary syndrome and ST elevation myocardial infarction [4]. 

E2. Editorial, Prophylaxis of dysrhythmias after myocardial infarction. Brit. Med. J. 1, 646 (1970). 

Metoprolol is nsed in moderate hypertension, serions conditions of myocardial infarction, for preventing death of cardiovascular tissue, in angina, tachycardia, extrasystole, and for secondary prophylaxis after a heart attack. The most common synonyms are lopresor, betaloc, and others. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

It is indicated in acute attacks (sublingually) and chronic prophylaxis (orally) of angina pectoris and coronary insufficiency. In acute myocardial infarction, CHF and acute LVF. 

It is indicated in pulmonary hypertension, prophylaxis of angina pectoris, post myocardial infarction therapy, CHF and acute LVF. It is not recommended for acute attacks of angina. 

It is indicated in prophylaxis in cases of increased risk of blood clotting, myocardial infarction, coronary bypass, transluminal angioplasty, stroke, transient ischaemic attack and unstable angina. 

Aspirin (acetylsalicylic acid, Figure 7.9) is a derivative of salicyclic acid, which was first used in 1875 as an antipyretic and antirheumatic. The usual dose for mild pain is 300-600 mg orally. In the treatment of rheumatic diseases, larger doses, 5-8 g daily, are often required. Aspirin is rapidly hydrolysed in the plasma, liver and eiythrocytes to salicylate, which is responsible for some, but not all, of the analgesic activity. Both aspirin and salicylate are excreted in the urine. Excretion is facilitated by alkalinisation of the urine. Metabolism is normally very rapid, but the liver enzymes responsible for metabolism are easily saturated and after multiple doses the terminal half-life may increase from the normal 2-3 h to 10 h. A soluble salt, lysine acetylsalicylic acid, with similar pharmacological properties to aspirin, has been used by parenteral administration for postoperative pain. Aspirin in low doses (80-160 mg daily) is widely used in patients with cardiovascular disease to reduce the incidence of myocardial infarction and strokes. The prophylaxis against thromboembolic disease by low-dose aspirin is due to inhibition of COX-1-generated thromboxane A2 production. Because platelets do not form new enzymes, and COX-1 is irreversibly inhibited by aspirin, inhibition of platelet function lasts for the lifetime of a platelet (8-10 days). 

The FDA has approved the use of 325 mg/d for primary prophylaxis of myocardial infarction but urges caution in this use of aspirin by the general population except when prescribed as an adjunct to risk factor management by smoking cessation and lowering of blood cholesterol and blood pressure. Meta-analysis of many published trials of aspirin and other antiplatelet agents confirms the value of this intervention in the secondary prevention of vascular events among patients with a history of vascular events. 

Indication Antiplatelet prophylaxis to reduce risk of recurrent transient ischemic attacks (TIA) and myocardial infarction (Ml)... 

Adjunct in the prophylaxis of systemic embolism after myocardial infarction... 

Small subcutaneous closes of heparin have been found to be effective in high-nsk post-surgical patients and in patients with acute myocardial infarction. The preventive treatment is commenced a few hours before an operative procedure and continued postoperatively for 4 to 5 days. As the result of a study in 1975. low-dose heparin prophylaxis in high-nsk patients who undergo abdomina-thoracic surgery has become a widely accepted practice, However, preventive anticoagulant therapy, to date, has been unsatisfactory and controversial in the instances of hip surgery or prostatectomy. 

In the case of aspirin, there are numerous reports of beneficial effects of low-dose aspirin in the secondary prophylaxis of cardiovascular disease (myocardial infarction and stroke). Aspirin clearly reduces the risk of myocardial infarction and stroke among patients who already have manifestations of cardiovascular disease. 

Wallentin L, Wilcox RG, Weaver WD, et al. Oral ximelagatran for secondary prophylaxis after myocardial infarction the ESTEEM randomised controlled trial. Lancet 2003 362 789-797. 

The major clinical uses of atenolol include hypertension angina pectoris acute myocardial infarction (MI) heart rhythm disturbances and migraine prophylaxis. In hypertonia disease, various studies have addressed the efficacy of atenolol in... 

Tisdale JE. Lidocaine prophylaxis in acute myocardial infarction. Henry Ford Hosp Med J 1991 39(3-4) 217-25. 

Dalteparin is a low-molecular-weight heparin that inhibits reactions that lead to clotting. Dalteparin sodium is indicated in the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embohsm in patients undergoing hip replacement surgery or in patients undergoing abdominal surgery who are at risk for thromboembolic complications and prophylaxis of ischemic comphcations in unstable angina and non-Q-wave myocardial infarction (MI) in patients on aspirin therapy. 

Timolol (10 mg t.i.d.) alone or in combination with other antihypertensive agents, such as thiazide diuretics, is used in the management of hypertension. Timolol is indicated for the treatment of myocardial infarction and prophylaxis of migraine headaches. Timolol (1 drop of 0.25% solution twice daily) is effective in lowering intraocular pressure in patients with chronic open-angle glaucoma. 

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