Table 2

Emergency drugs for the treatment of percutaneous coronary intervention complications

IndicationDrugInitial doseRoutePreparation and administration
HypotensionMetaraminol0.5–1 mgIntravenousDilute 1 mL of metaraminol 10 mg/1 mL solution to 20 mL with normal saline (1 mL=0.5 mg). Administer 1–2 mL intravenously. Repeat as necessary.
Phenylephrine100–500 μgSlow intravenousPhenylephrine 1 mg/10 mL solution (1 mL=100 μg). Administer 1–5 mL. Phenylephrine 10 mg/1 mL solution: dilute 1–10 mL with normal saline. Discard 9 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Administer 1–5 mL. Repeat as necessary.
AnaphylaxisHigh-flow oxygen and anaesthetic support
Crystalloid500–1000 mLIntravenousFluid challenge. Repeat as necessary.
Epinephrine50–100 μgIntravenousDilute 1 mL of epinephrine 1:1000 to 10 mL with normal saline (1 mL=100 μg). Administer 0.5–1 mL intravenously. Repeat as necessary.
 500 μgIntramuscular0.5 mL of epinephrine 1:1000.
Hydrocortisone200 mgIntramuscular or slow intravenousStat dose.
Chlorphenamine10 mgIntramuscular or slow intravenousStat dose.
BleedingProtamine25–50 mgIntravenous1 mg neutralises 80–100 units of unfractionated heparin when given within 15 min (if longer than 15 min since heparin, less protamine required). Rate not to exceed 5 mg/min. Maximum dose 50 mg.
Packed red cells, platelets and fresh frozen plasmaIntravenousConsider activating local major haemorrhage protocol.
No-reflowNitrates100 μg–1 mgIntracoronaryDilute 1 mL of isosorbide dinitrate 10 mg/10 mL solution to 10 mL with normal saline (1 mL=100 μg). Administer 1–10 mL. Repeat as necessary.
Adenosine100 μgIntracoronaryDraw 1 mL from a 2 mL phial (6 mg/2 mL solution) in a 10 mL Luer-Lok syringe. Dilute to 9 mL total with normal saline and mix. Discard 6 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Deliver 1 mL aliquots via microcatheter or aspiration device. Up to 4 mg over 1 min.
Verapamil100–200 μgIntracoronaryDraw 1 mL from a 2 mL phial (5 mg/2 mL solution) in a 10 mL Luer-Lok syringe. Dilute to 10 mL total with normal saline and mix. Discard 6 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Deliver 1–2 mL aliquots via microcatheter or aspiration device. Up to 1 mg.
Sodium nitroprusside100–200 μgIntracoronaryAdd 50 mg powder and solvent for solution for infusion phial to 500 mL of 5% glucose (1 mL=100 μg). Deliver 1–2 mL aliquots via microcatheter or aspiration device. Up to 1 mg.
ThrombusAbciximabDose based on weightIntracoronary, intravenousReconstitute as per manufacturer’s instructions. Give loading followed by maintenance dose according to weight-based dosage table.
TirofibanDose based on weightIntracoronary, intravenousHigh bolus dose regimen—bolus 25 μg/kg over 2–3 min, and then 0.15 μg/kg/min for 12 hours.54
Alteplase200–300 μgIntracoronaryReconstitute Actilyse 10 mg or 20 mg powder and solvent for solution for injection—1 mg in 1 mL. Draw up 1 mL and make up to 10 mL with normal saline (1 mL=100 μg). Dose 2–3 mL (200–300 μg).