- bed rest,
- anti-platelet therapy,
- anticoagulation and
- a ß-blocker.
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| Algorithm for risk stratification and treatment of patients with UA/NSTEMI. DM= diabetes mellitus; Rx = treatment. Updated with permission from Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, Pa: W.B. Saunders; 2001:1232–1263.[Source] |
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| Recommendations for antithrombotic therapy based on the 2002 ACC/AHA Guidelines for UA/NSTEMI Risk Stratification scheme. Cath = cardiac catheterization; SQ = subcutaneous. The figure is updated by the authors, with changes in italics, from a figure which appeared in the 2000 Guideline (Braunwald E, et al J Am Coll Cardiol. 2000;36:970–1056).[Source] |
A systematic review found that aspirin alone (75–325 mg/day) reduces the risk of death and myocardial infarction in patients with UA.
A large, randomised, control trial (RCT) has shown that the combination of clopidogrel (75 mg/day) and aspirin is superior to aspirin alone.
Many RCTs have found that treating those patients at risk of UA with low molecular weight heparin (LMWH) is more effective than aspirin alone.
The advantages of LMWH over unfractionated heparin include
- its ease of administration and
- no need for monitoring.
Patients with a high risk of UA should be considered for revascularisation.
Those who undergo coronary angioplasty should also be considered for treatment with an intravenous glycoprotein IIb/IIIa inhibitor such as
- abciximab,
- tirofiban or
- eptifibatide.
- Cannon CP, Turpie AG. Unstable angina and non–ST-elevation myocardial infarctioninitial antithrombotic therapy and early invasive strategy. Circulation 2003;107:2640-2645.[Free Full Text]
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