Cardiovascular CG94 Unstable Angina and NSTEMI
Following medical treatment including aspirin and anti-thrombin (LMWH Fondaparinex), a formal risk assessment for 6 month mortality should be carried out including previous CVD HX, Exam, 12 lead ECG, Biomarkers. > 1.5% low, > 6 % considered high
Risk assessment: Global Registry of Acute Cardiac Events [GRACE]
Aspirin 300 mg loading dose unless contra-indicated
Clopidogrel 300 mg if 6 mth risk > 1.5% OR who may undergo PCI within 24 hrs OR Any patient whose had an NSTEMI, for up to 12 mths post event
Glycoprotein IIb,IIIa inhibitors (Eptifibatide) if risk > 3 %, and schedule angiography within 96 hrs
LMWH Fondaparinex unless coronary angiography planned within 24 hrs, and who do not have high bleed risk
Unfractionated heparin if coronary angiography within 24 hrs, or if renally impaired (eGFR < 30)
Note: Consider Bivalirudin instead of heparain and GPI if angiography within 24 hrs
Coronary angiography with PCI as necessary within 24 hrs if 6 mth mortality risk > 3 %, or if initially < 3 % but subsequently experiences ischaemia
If revascularisation unclear then involve surgeon and interventionalist
Consider ischaemia testing before discharge
. Summary compiled by CG94 Unstable angina and NSTEMI: early management Dr D P Sheppard MBBS.
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