UA/NSTEMI: A Guideline Update

UA/NSTEMI: A Guideline Update

Following the recent FDA approval of new medications to reduce cardiovascular death and heart attack in patients with acute coronary syndromes (ACS) and developments in the literature, the American College of Cardiology (ACC) and American Heart Association (AHA) released a focused update to 2007 guidelines on the management of patients with unstable angina (UA)/NSTEMI. The update, published in Circulation, focuses on how antiplatelets and anticoagulants fit into management algorithms for ACS. Key Updates to UA/NSTEMI Guidelines An important change in the ACC/AHA guideline update is that ticagrelor is now considered a treatment option for UA/NSTEMI patients, joining clopidogrel and prasugrel. “We recommend that when aspirin is given with ticagrelor for maintenance therapy, a low dose of aspirin (81 mg) should be used after the initial loading dose,” says Jeffrey L. Anderson, MD, FACC, FAHA, co-author of the guidelines. “Research shows that a high dose of aspirin appears to reduce the benefits of ticagrelor.” Aspirin remains a first-line therapy for managing patients with UA/NSTEMI. “When these patients arrive at the hospital, they should receive aspirin and an anticoagulant,” says Dr. Anderson. “Clinicians should then decide upon a second antiplatelet agent before angiography to define coronary anatomy. Clopidogrel, ticagrelor, or an intravenous glyco­protein IIb/IIIa agent are acceptable options. At or after coronary stenting, prasugrel becomes an additional option.” For patients receiving medical therapy only, the ACC/AHA guidelines recommend antiplatelet therapy with ticagrelor or clopidogrel, in addition to aspirin. Several changes were made in the guideline update regarding patients with renal insufficiency. “It’s important to assure that these patients are well hydrated if they’re going to the cath lab and that they...

Resuming Blood Thinner Use After a GI Bleed

Among patients with a warfarin-associated index gastrointestinal (GI) bleeding event, the decision to not resume warfarin within 90 days appears to be associated with higher risks for thrombosis and mortality. A cohort study demonstrated that resuming warfarin did not significantly increase the risk for recurrent GI bleeding. Abstract: Archives of Internal Medicine, September 2012...