NJ MICU to administer P2Y12 inhibitor at point of contact

The Hunterdon Medical Center's Mobile Intensive Care Unit receives approval to add Brilinta to its STEMI patient care protocol


FLEMINGTON, N.J. — Hunterdon Medical Center's Mobile Intensive Care Unit (HMC MICU) adds a P2Y12 inhibitor, Brilinta an antiplatelet drug, to their medication boxes on all their mobile units.  

The drug is for patients experiencing an ST-Elevation Myocardial Infarction (STEMI). The addition of Brilinta allows treatment at the point of patient contact and drug effect early in the course of the STEMI.

"Early treatment of a completely blocked artery minimizes the extent of the heart muscle damage and preserves the pumping function of the heart which can help increase survival,” said Martin Hogan, Director of Hunterdon Medical Center's Mobile Intensive Care Unit.  

The onset of orally administered Brilinta is about 20 minutes.

“By receiving this medication in the field the rapid ingestion through the GI tract and direct bio-availability to the clot, stands to result in a significantly softer clot," said Hogan.

Based on available scientific evidence and guidelines, HMC MICU chose Brilinta (ticagrelor) as its P2Y12 inhibitor of choice as it extends the reach of the emergency department into the field at the point of first patient contact.

Once the patient arrives to the emergency department and eventually the catheterization lab, the interventional cardiologist can perform emergency angioplasty, which results in a mechanical disruption of the obstruction, thereby allowing delivery and deployment of a stent to maintain the flow through the artery.

The HMC approach to STEMI includes a multi-disciplinary team.

“The MICU is contributing significantly to the process through the early interventions of STEMI recognition, IV's, MONA and now Brilinta,” Hogan said.

It took a collaborative initiative to add P2Y12 inhibitors to the HMC MICU medication formulary, which is approved by the Department of Health. The importance of administering P2Y12 inhibitors in the field as opposed to waiting until the patient arrives at the emergency department was presented to the N.J. Department of Health Mobile Intensive Care Unit Medical Advisory Council (MAC).  

“The American College of Cardiology Guidelines are clear on this issue. They state that these drugs are the mainstay of therapy for STEMI patients and should be administered as early as possible after diagnosis,” said Andrey Espinoza, M.D., HMC Interventional Cardiologist. “For us that is at the point of first contact with the patient encountered by the MICU. Why wait 20 or 30 minutes for the patient to arrive in the ED to give the same exact medications?”

The practice of administering Brilinta to patients at the time they are having a heart attack rather than at some point in the future is not revolutionary.

“This practice has been commonplace in Europe and other parts of the world for many years,” Espinoza said. “We are finally catching up.”

The MAC committee endorsed that anti-platelet medications be added to their the optional formulary and the N.J. Department of Health approved and granted this be added to all Mobile Units, throughout NJ.

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