Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 52

The elevated troponin often results from the combination of stable CAD and demand ischemia from anemia and tachycardia. Therefore, the treatment of anemia is the first and most important line of therapy. The patients should receive fluid resuscitation ± blood transfusion (particularly in hemodynamic instability, severe tachycardia, persistent angina, or Hb <8 g/dl). PPI therapy is initiated, and endoscopy is performed if appropriate, usually before any coronary procedure. A coronary procedure, with the possible ensuing need for anticoagulation and antiplatelet therapy, should only be performed after stabilization and etiologic diagnosis of the GI bleed, typically several days later or, if possible, in an angina-free patient, weeks later.

Similarly, a patient with stable angina who has chronic anemia should undergo anemia workup before any potential coronary procedure.

A coronary procedure is performed more urgently and potentially before the GI procedure in rare cases: (i) STEMI, (ii) ACS with ongoing angina despite transfusion, or (iii) major ST changes or severe troponin rise occurring with a rather mild or chronic anemia.