UA/NSTEMI

ÎÎFor UA/NSTEMI patients in whom medical therapy is selected as a management strategy and in whom no significant obstructive CAD on angiography was found, antiplatelet and anticoagulant therapy should be administered at the discretion of the clinician (I-C). ÎÎFor patients in whom evidence of coronary atherosclerosis is present (eg, luminal irregularities or intravascular ultrasound-demonstrated lesions), albeit without flow-limiting stenoses, long-term treatment with ASA and other secondary prevention measures should be prescribed. (I-C) ÎÎFor UA/NSTEMI patients in whom medical therapy is selected as a management strategy and in whom CAD was found on angiography, the following approach is recommended: •  Continue ASA. (I-A) •  Administer a loading dose of clopidogrel or ticagrelor (See Table 3) if not given before diagnostic angiography. (I-B) •  Discontinue IV GP IIb/IIIa inhibitor if started previously. (I-B) •  Anticoagulant therapy should be managed as follows: ▶▶ Continue IV UFH for ≥48 hours or until discharge if given before diagnostic angiography. (I-A) ▶▶ Continue enoxaparin for duration of hospitalization, ≤8 days, if given before diagnostic angiography. (I-A) ▶▶ Continue fondaparinux for duration of hospitalization, ≤8 days, if given before diagnostic angiography. (I-B) ▶▶ Either discontinue bivalirudin or continue at a dose of 0.25 mg/kg/h for up to 72 h at the physician's discretion if given before diagnostic angiography. (I-B) ÎÎFor UA/NSTEMI patients in whom a conservative strategy is selected and who do not undergo angiography or stress testing: •  •  •  •  Continue ASA indefinitely. (I-A) Continue clopidogrel or ticagrelor (See Table 3) for ≤12 months. (I-B) Discontinue IV GP IIb/IIIa inhibitor if started previously. (I-A) Continue UFH for 48 hours (I-A) or administer enoxaparin (I-A) or fondaparinux (I-B) for the duration of hospitalization, ≤8 days, and then discontinue anticoagulant therapy. ÎÎFor UA/NSTEMI patients in whom an initial conservative strategy is selected and in whom no subsequent features appear that would necessitate diagnostic angiography (recurrent symptoms/ischemia, HF, or serious arrhythmias), LVEF should be measured. (I-B) ÎÎFor UA/NSTEMI patients in whom PCI has been selected as a postangiography management strategy, it is reasonable to administer an IV GP IIb/IIIa inhibitor (abciximab, eptifibatide, or tirofiban) if not started before diagnostic angiography, particularly for troponinpositive and/or other high-risk patients. (IIa-A) 25

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