Figure 3. Algorithm for Management of Patients With Definite
or Likely NSTE-ACS
a
Treatment
12
Ischemia-Guided
Strateg y
Initiate DAPT and
Anticoagulant Therapy
1. ASA (Class I; LOE: A)
2. P2Y
12
inhibitor (in addition to ASA)
(Class I; LOE: B):
• Clopidogrel or
• Ticagrelor
3. Anticoagulant:
• UFH (Class I; LOE: B) or
• Enoxaparin (Class I; LOE: A) or
• Fondaparinux
b
(Class I; LOE: B)
Therapy
Ineffective
Therapy
Effective
NSTE-ACS:
Definite or Likely
Medical therapy
chosen based on
cath findings
PCI With Stenting
Initiate/continue antiplatelet and anticoagulant therapy
1. ASA (Class I; LOE: B)
2. P2Y
12
inhibitor (in addition to ASA):
• Clopidogrel (Class I; LOE: B) or
• Prasugrel (Class I; LOE: B) or
• Ticagrelor (Class I; LOE: B)
3. GPI (if not treated with bivalirudin at time of PCI):
• High-risk features, not adequately pretreated with clopidogrel (Class I; LOE: A)
• High-risk features adequately pretreated with clopidogrel (Class IIa; LOE: B)
4. Anticoagulant:
• Enoxaparin (Class I; LOE: A) or
• Bivalirudin (Class I; LOE: B) or
• Fondaparinux
b
as the sole anticoagulant (Class III: Harm; LOE: B) or
• UFH (Class I; LOE: B)
