Unstable angina non ST elevation myocardial infarction anticoagulant therapy
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Unstable angina non ST elevation myocardial infarction anticoagulant therapy On the Web |
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to Hospitals Treating Unstable angina non ST elevation myocardial infarction anticoagulant therapy |
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.
Overview
Anticoagulation, traditionally with unfractionated heparin (UFH), is a cornerstone of therapy for patients with Unstable angina/NSTEMI. Some of the agents available in this category include:
- unfractionated heparin,
- low molecular weight heparin,
- Direct Thrombin Inhibitors (e.g.,bivalirudin)
- Factor Xa Inhibitors (e.g.,fondaparinux), and
- warfarin.
These agents are also sometimes referred to as antithrombins, although, it should be noted that they often inhibit one or more proteins in the coagulation cascade before thrombin.
Anticoagulant therapy in UA/NSTEMI
- You can read in greater detail about each of the therapies below in greater detail by clicking on the link for that therapy.
Unfractionated Heparin | Low Molecular Weight Heparin | Direct Thrombin Inhibitors | Factor Xa Inhibitors | Long Term Anticoagulation
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)[1]
Anticoagulant Therapy (DO NOT EDIT)[1]
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"1. Anticoagulant therapy should be added to antiplatelet therapy in UA / NSTEMI patients as soon as possible after presentation. |
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a) For patients in whom an invasive strategy is selected, regimens with established efficacy at a (Level of Evidence: A) include enoxaparin and UFH, and those with established efficacy at a (Level of Evidence: B) include bivalirudin and fondaparinux. |
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b) For patients in whom a conservative strategy is selected, regimens using either enoxaparin or UFH (Level of Evidence: A) or fondaparinux (Level of Evidence: B) have established efficacy. See also Class IIa recommendation below. |
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c) In patients in whom a conservative strategy is selected and who have an increased risk of bleeding, fondaparinux is preferable. (Level of Evidence: B)" |
| Class IIa |
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"1. For UA / NSTEMI patients in whom an initial conservative strategy is selected, enoxaparin or fondaparinux is preferable to UFH as anticoagulant therapy, unless CABG is planned within 24 h. (Level of Evidence: B)" |
See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [2]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE; et al. (2011). "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 123 (18): e426–579. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888.
- ↑ Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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