Anticoagulant Therapies, NSTE-ACS Guidelines and Translation

to Clinical Practice, 2013

Keith A.A. Fox,

non-ST-segment elevation acute coronary syndrome (NSTE-ACS): the

acute therapies in NSTE-ACS
to discuss how the novel therapies that are not yet approved may apply
in these cases.

A 63-year-old man presents to the emergency department at 10 p.m.

for evaluation of chest pain.
He reports a history of peripheral arterial disease, tobacco use, and
hypertension.
His current medication regimen includes low-dose aspirin and
amlodipine. On presentation his physical exam reveals a blood pressure
of 144/70, heart rate of 94 bpm. His peripheral pulses are weak.
Electrocardiogram shows 1 mm horizontal ST depressions in leads 2,
3, aVF.
Lab evaluation shows a normal creatinine of 1.0 mg/dl and an elevated
troponin.
DG.: non-ST-segment elevation myocardial infarction (NSTEMI).
He becomes chest pain free, and the decision is made to perform
coronary angiography at 8 a.m. the next morning.
Prior to coronary angiography, in addition to aspirin, what
additional antiplatelet therapy would you administer to this patient
at this time?
Clopidogrel
Prasugrel
Ticagrelor
Monotherapy with aspirin alone until after coronary angiography
Prior to coronary angiography, what anticoagulant therapy would
you initiate in this patient?
Bivalirudin
Fondaparinux
Unfractionated heparin (UFH)
 No addition of anticoagulant therapy until after coronary angiography

Coronary angiography is performed and reveals a 90% stenosis in the

proximal right coronary artery (RCA).
A drug eluding stent is successfully inserted with minimal
residual stenosis.
Upon discharge, in addition to aspirin, which antiplatelet therapy would
you give this patient?
Clopidogrel
Prasugrel
Ticagrelor
Aspirin alone