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 at least 48 hours or until discharge if given before
diagnostic angiography. (I-A)
▶▶ Continue enoxaparin for duration of hospitalization, up to 8 days, if given
before diagnostic angiography. (I-A)
▶▶ Continue fondaparinux for duration of hospitalization, up to 8 days, if given
before diagnostic angiography. (I-B)
▶▶ Either discontinue bivalirudin or continue at a dose of 0.25 mg/kg per
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 up to 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, up to 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)
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