This document presents a retrospective observational study on drug profiles and post-lysis complications in patients with myocardial infarction. The study analyzed 100 patients admitted with ST elevation myocardial infarction. The most common drugs administered were streptokinase, aspirin, clopidogrel, and atorvastatin. The most frequent post-lysis complications observed were bleeding (68% of patients) and hypotension (53% of patients). The study aims to evaluate treatment efficacy and risks associated with myocardial infarction by analyzing patient drug regimens and complications.

1. Presentedby:
Sameer Sharad Shete
Jyotsna Bhaskar Jagtap
Ajinkya Sunilrao Powale
Sanket Bandu Shinde
Pankaj Narendra Shirsath
DRUG PROFILE IN MYOCARDIAL INFARCTION WITH
MONITORING OF POSTLYSIS COMPLICATIONS
A Retrospective Observational Study
Under the Guidance of
Guide Co-Guide
Dr. P.R. Patil Dr. Anil Joshi
Assistant Professor Assistant Professor
GOVERNMENT COLLEGE OF PHARMACY
DR. BABASAHEB AMBEDKAR MARATHWADA UNIVERSITY
AURANGABAD (M.S.) 431005, INDIA
2016-2017

3. • INTRODUCTION
• As Acute myocardial infarction is a one of the leading cause of death,
critical analysis of both drug profile associated with STEMI as well as post
thrombolysis complications is a need of time.

4. • Classification Of Acute Coronary Syndromes

5. Pathophysiological Characteristics Of Myocardial Infarction

6. Sequential Pathologic Changes In Myocardial Infarction.

7. EPIDEMIOLOGY
• An estimated 17.7 million people died from CVDs in 2015, representing
31% of all global deaths. Of these deaths, an estimated 7.4 million were
due to coronary heart disease.

8. Clinical Presentation
Chest pain Diaphoresis
Shortness
of breath
Nausea Vomiting

9. DIAGNOSIS
• ECG Changes
• CK – MB
• LDH
• Troponin
• C – reactive protein
• Brain ( B – Type ) natriuretic peptide (BNP)

10. Drug Profile
• Antithrombotic Agents
• Other Thrombolytic Agent
• Beta-Adrenoceptor Blockers :
• ACE Inhibitors
• GP IIb /IIIa Receptor Inhibitors
• Selective Factor Xa Inhibitors
• Alteplase
• Anistreplase
• Reteplase
• Tenecteplase
• Direct Thrombin Inhibitors
• Other agents
• Statins
• Nitrates
• Analgesics
• Oxygen
• Nonpharmacological Therapy

11. Complications In Myocardial Infarction
1. Arrhythmia
2. Cardiogenic Shock
3. Right Ventricular Infarction
4. Pericarditis

12. • REVIEW OF LITERATURE
Author Name of study No of patients Method Results
Azmat Ehsan Qureshi
et al
To evaluate the safety of most
commonly used thrombolytic
streptokinase in elderly patients
presenting with acute
myocardial infarction.
100 Descriptive case
series
The two most common
complications of streptokinase were
hypotension (33%) and bleeding
(19%). Major bleed occurred only in
3(3%) patients. No patients
developed intracranial
haemorrhage. Other complications
included arrhythmia (6%) , allergic
reactions (4%). No patient died of
streptokinase related complications.
Use of streptokinase for acute
myocardial infarction should not be
discouraged in the elderly.
Jaume Marrugat et al To determine incidence of MI in
the 65 year and older
population
493003 Prospective study MI incidence increased with age
after 64
Fritz Huthasaari To explore whether the use of
tobacco affects the risk of MI
687 Population based
study
Risk of MI is more in tobacco
chewing.

13. Author Name of study No of patients Method Results
Soheila Dabiran et al To assess difference of
prevalence of MI risk factors
in elderly and nonelderly
patients
Age>65
:n=1060 and
age<65 ; n=
2228
The Retrospective
study
In MI patients HTN and Diabetes
were more common in elderly than
non-elderly group.
Manjula Devi. A.S. et al To assess rationality of fixed
dose combination (FDC) of
cardiovascular drug in
multidisciplinary hospital,
India
100
prescription
analysed
The Prospective
Descriptive study.
The result indicated that most of
the prescribed cardiovascular FDCs
in the multidisciplinary tertiary care
hospital selected were rational and
found to comply with the seven
point criteria scale.
Neal S. Kleiman et al To assess Mortality Within 24
Hours of Thrombolysis for
Myocardial Infarction
41021 Randomized control
trial
There were 1125 early deaths
(2.8%) and 1726 additional later
deaths (4.2%). Thus, 39% of all
deaths occurred within 24 hours. Six
hundred forty-one early deaths
(57%) occurred within the first 6
hours after beginning thrombolytic
therapy. The median time from
randomization to initiation of
thrombolytic therapy was 35
minutes.

14. Author Name of study No of patients Method Results
Javid A Malik et al To study adverse effect profile
of streptokinase therapy in
patients with acute
myocardial infarction.
Out of 163
patients of
AMI ,102 were
thrombolyzed
A Prospective study The commonest complication
observed was bleeding from various
sites that occur in 11(10.7%)
patients. Second most common
complication was hypotension that
affected six (5.8%) patients
including 3 males and 3 females
who had a mean age of 52 years.
P Owens et al To study hypotension occur in
patient of AMI
266 Observational study Out of 266 patients AMI; 107
hypotensive events were
documented also 75 bleeding
events were occur.
Sricharan K.N. et al To study AMI in young adult
with various risk factors.
42000 Prospective
observational study
The mean age of patients with MI
was 37.03yrs, smoking was most
common factor in young adult and
most common symptoms was chest
pain(90%) followed by
sweating(50%) breathlessness
(20%).

15. Author Name of study No of patients Method Results
Marcia Regina Pinho
Makdisse et al
To assess the changes in the
medication of elderly patients
hospitalized with AMI .
379 Retrospective study In treatment of elderly patients with
AMI greater use of beta-blockers
and ACEI and lowering use of CCB
and antiarrhythmic drugs.
E. borner et al To assess mortality rate as
well as complications after
lyse with STK
136 Retrospective study The total mortality was 26% with an
average age of 76.5yrs and it is
reduced to 14% in the patients
under 70 yrs with average age of
58.9yrs. Bleeding was the most
common complication.
Kiran P. Vakade et al A study of prescribing pattern
of drugs in patients of
cardiovascular emergencies at
a tertiary care hospital of
Western Maharashtra
182 A Prospective study Aspirin clopidogrel combination
(80.49%), enoxaparin (75.61%),
atorvastatin (73.17%), glyceryl
trinitrate (73.17%) were the most
commonly prescribed drugs. The
utilization rate of ACE inhibitors and
ARBs (56.10%) was found higher
than that of beta blockers (28.05%).
Stool softeners (52.46%) and
anxiolytics (28.58%).

16. • AIMS AND OBJECTIVES
• AIM : To assess Drug Profile In Myocardial Infarction With
Monitoring Of Postlysis Complications.
• Objectives :
1 ] Primary : To study the drug profile of Myocardial infarction.
2] Secondary :
a] To access the Efficacy of treatment of Myocardial infarction.
b] To evaluate the risk factors and post thrombolysis complications
associated with Myocardial infarction.

17. • MATERIALS AND METHODS
Study Design Source of Data Sample size Inclusion criteria Exclusion criteria
5 months retrospective
observational study on
patients of STE
Myocardial Infarction
with or without
complications.
In patient department
of medicine and
Intensive cardiac unit
of study centre
100 patients All patients which are
diagnosed with STE
Myocardial Infarction
All patients other than STE
Myocardial Infarction.
Methods and collection of data: 1] Data collection :The consented participants were
enrolled in the present study. Descriptive data like name, age, sex, religion, occupation,
personal history like diet, addiction were obtained by interviewing the patients.
Each of the patients proper history was recorded on predesigned and pretested proforma.
2] Investigations: ECG changes
Symptoms:
- Post thrombolysis bleeding
- Vomiting
- Dyspnoea
- Diaphoresis

18. • OBSERVATIONS AND RESULTS
Differentiation On The Basis Of Age :
Age in years No of Patients Percentage (%)
< 40 years 5 5
40 - 60 years 50 50
> 60 years 45 45
Total 100 100
0
5
10
15
20
25
30
35
40
45
50
< 40 years 40 - 60 years > 60 years
No. of Patients
No of Patients

19. Differentiation On The Basis Of Gender :
Patients No of patients Percentage (%)
Male 78 78
Female 22 22
0
10
20
30
40
50
60
70
80
Male Female
No of Patients
No of Patients

20. Differentiation On The Basis Of Chief complaints on admission :
Type of complain No. of patients Percentage (%)
Chest pain 100 100
Palpitation 30 30
Sweating 58 58
Vomiting 20 20
Breathlessness 41 41
Heartburn 2 2
Giddiness 09 09
0
10
20
30
40
50
60
70
80
90
100
Chest pain Palpitation Sweating Vomiting Breathlessness Heartburn Giddiness
No. of Patients
No. of Patients

21. Differentiation On The Basis Of Risk factors :
Risk factors No. of patients Percentage (%)
Alcohol Consumption 27 27
Tobacco 23 23
Smoking 19 19
Age 34 34
Hypertension 44 44
0
5
10
15
20
25
30
35
40
45
Alcohol Consumption Tobacco Smoking Age Hypertension
No. of Patients
No. of Patients

22. Differentiation On The Basis Of Drug Profile :
Name of drug Standard Dose Frequency No. of patients Percentage (%)
Streptokinase 15 lac IU Stat ( 60 min ) 100 100 %
Aspirin 75–162 mg Once Daily 100 100 %
Clopidogrel 75 mg Once Daily 100 100 %
Atorvastatin 40 mg Once Daily 100 100 %
LMH (Enoxaparin) 1 mg/kg Once Daily 100 100 %
Isosorbide Dinitrate 0.4mg (SL) 5 min × 3 doses 91 91 %
Ramipril 5 mg Twice a day 39 39 %
Combination ( RM + MTP ) 5mg + 50 mg Twice a day 28 28 %
0
20
40
60
80
100
No. of Patients
No. of Patients

23. Differentiation On The Basis Of Post Thrombolysis Complications :
Type of complication No. of patients Percentage (%)
Hypotension 53 53
Bleeding 68 68
Nausea 28 28
Vomiting 31 31
Sweating 48 48
Dizziness 18 18
Death 03 03
Weakness 18 18
0
10
20
30
40
50
60
70
Hypotension Bleeding Nausea Vomiting Sweating Dizziness Death Weakness
No. of Patients
No. of Patients

24. RESULT IN-HOUSE STUDY REFERENCE STUDY
RISK FACTOR
GENDER M : 78 % F : 22 % M : 77 % F : 23 %
[ Azmat ehsan Qureshi et al.]
AGE 40 – 60 years 64 [ Jaume marrugat et al ]
DRUG PROFILE
Streptokinase 100 % 100 %
Aspirin 100 % 80.49 %
Clopidogrel 100 % 80.49 %
Atorvastatin 100 % 73.17 %
LMWH 100 % 75.61 %
Metoprolol + Ramipril 28 % 56.10 %
Ramipril 39 % 56.10 %
[ Kiran P. Wakade et al ]
COMPLICATION
Bleeding 68 % 70 %
Hypotension 53 % 58 %
[ Javid A Malik et al ]
• Comparative Discussion On Drug Profile & Complications Of AMI

25. • Summary and Conclusion
• Streptokinase, Aspirin, Clopidogrel and Atorvastatin had administered in every patient.
• 68 % of patients were observed with bleeding as a major post thrombolysis complication.
• 53 % patients found to be hypotensive after thrombolysis.
• Apart from bleeding as a major complication, nausea and vomiting also found in significant
percentage as a post thrombolysis complication with 28% and 31 % respectively in AMI
patients.
• 48 % patients were complained about excess sweating after thrombolysis.
• 18 % patients were feeling giddiness after thrombolysis.
• 18 % patients were feeling weakness after thrombolysis.
• 3 % patients died after thrombolysis in spite of them being treated with all standard of care
available at the hospital.

26. • Limitations
• Sample of the population of AMI ( Single centre study)
• Use of Other thrombolytic agents
• Laboratory testing ( Troponin, CK – MB, LDH, Myoglobin)

27. Case proforma
DRUG PROFILE IN MYOCARDIAL INFARCTION WITH MONITORING OF
POSTLYSIS COMPLICATIONS
GOVERNMENT MEDICAL COLLEGE , AURANGABAD
PATIENT NAME
MRD. NO
AGE: WEIGHT: SEX: M/F:
DATE OF ADMISSION:
DATE OF DISCHARGE:
MOBILE NO:
COMPLAINTS ON ADMISSION:
PAST HISTORY:
MEDICATION HISTORY:
FAMILY HISTORY:
PERSONAL HISTORY:
RISK FACTORS:
ALCHOLIC CONSUMPTION:
OBESITY : AGE : SEX:
HYPERTENTION:
SMOKING: TOBACCO:
TB : HIV: COPD:
DM: HYPERLIPIDEMIA : RENAL FAILURE:
PREVIOUS IHD HISTORY:

28. GENERAL EXAMINATION
PR:/MIN:
BP: mmHg
R.R. Cycles/min
SYSTEMIC EXAMINATION:
CVS:S1 S2
P/A:
Cynosis,clubbing,lymphadenopathy,oedema
RS:
CNS :
LABORATORY INVESTIGATION:
LIPID PROFILE :
CHOLESTEROL: mg/dl TRIGLYCERIDES: mg/dl
LDL: mg/dl HDL: mg/dl
CARDIAC LAB:
CREATINE KINASE AND CREATININ PHOSPHOKINASE:
CREATINE KINASE MALE : U/L
CREATINE KINSE FEMLE : U/L
CK-MB CK isoenzyme
LDH (LACTATE DEHYDROGENASE)
LDH-1: %
LDH2: %
SGPT:
SGOT:
MYOGLOBIN,SERUM (male): ug/ml
MYOGLOBIN,SERUM(female): ug/ml
TROPONIN I: ug/ml
TROPONIN T: ug/dl
ECG MONITORING:
2D ECHO:
CHEST X-RAY:
ANGIOGRAAM:
DIAGNOSIS:
TREATMENT CHART:
DRUG NAME DOSE FREQUENCY DURATION
COMPLICATION:
ISCHEMIC:
ANGINA: REINFRACTION : EXTENSION:
MECHANICAL:
CHF:
CARDIAO-SHOCK: MV dysfunction: aneurysms: Cardiac rupture:
Arrhythmic-
Atrial or vent: sinus or node dysfunction:
Embolic-
CNS/Peripheral:
Inflammatory:
Pericarditis:
During lysis:
Pump failure:
Arrhythmia:
Hypotension:

29. Thromboembolism:
Acidosis
Death:
After lysis:
Hypotension:
Bleeding:
Nausea: vomiting:
Pain:
Sweating: dizziness: weakness:
Allergic reaction:
Anaphylaxis:
Others:
Multiple micro emboli:
Death:
Other complications:
THROMBOLYSIS NOTES
THROMBOLYSE WITH :
TIME B.P. PR