Unstable angina non ST elevation myocardial infarction long term anticoagulation therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.

Long Term Anticoagulation

Warfarin is the typical drug used for long term anticoagulation. However, its role, if any, in patients with UA/NSTEMI has not been clearly defined.

Clinical Trial Data

ASPECT 2 trial showed that in patients recently admitted with ACS, treatment with high-intensity oral anticoagulants or aspirin with medium-intensity oral anticoagulants was more effective than aspirin alone in reduction of subsequent cardiovascular events and death. However, similar benefit is seen with clopidogrel plus aspirin over aspirin alone, the lack of need for monitoring of the INR, and the frequent use of PCI and stenting in the patient population in whom the need for clopidogrel is well established, the clinical use of aspirin plus warfarin is limited. Among patients without a coronary stent but with another indication for warfarin, such as chronic atrial fibrillation, mechanical valve or severe left ventricular dysfunction who are at high risk of systemic embolization, the combination of aspirin plus warfarin would be preferable as the long-term antithrombotic strategy.