ACUTE CORONARY SYNDROME-ANTICOAGULANT OR ANTIPLATELET TX

SUMMARY

1. Unfractinated heparin is preferred if CABG or coronary angiography is anticipated within 24 hours.
2. Enoxaparin is commonly used; dose should be adjusted in patients with renal impairment.
3. Fondaparinux can be considered if the patient has increased risk of bleeding.

ANTI-PLATELET AGENTS
4. Administer aspirin (162 or 325 mg) to patients with ACS, continue indefinitely unless CI.
5. Thienopyridines include clopidogrel, and prasugrel. Their effect is additive to aspirin. These drugs block the ADP receptor PGY₁₂ on platelets.
6. Clopidogrel requires a liver enzyme (CYP2C19) to become active. Overall, 2-14% are poor metabolizers.
7. Ticagrelor is more effective than Clopidogrel with no increase in bleeding risk.

FIBRINOLYTIC THERAPY
8. Not suitable for NSTEMI as it increases mortality, suitable for STEMI if PCI is not available & no CI.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].