Treatment
Nitroglycerin
ÎÎNTG to treat ischemic symptoms is recommended. (I-C)
Calcium Channel Blockers
ÎÎCalcium channel blockersa are recommended for ischemic symptoms
when beta blockers are not successful. (I-B)
ÎÎCalcium channel blockersa are recommended for ischemic symptoms
when beta blockers are contraindicated or cause unacceptable side
effects. (I-C)
a
Short-acting dihydropyridine calcium channel antagonists should be avoided.
Warfarin
ÎÎUse of warfarin in conjunction with ASA and/or P2Y12 receptor
inhibitor therapy is associated with an increased risk of bleeding, and
patients and clinicians should watch for bleeding, especially GI, and
seek medical evaluation for evidence of bleeding. (I-A)
ÎÎWarfarin either without (international normalized ratio [INR] 2.5-3.5)
or with low-dose ASA (81 mg daily; INR 2.0-2.5) may be reasonable for
patients at high CAD risk and low bleeding risk who do not require or
are intolerant of P2Y12 receptor inhibitor therapy. (IIb-B)
ÎÎTargeting oral anticoagulant therapy to a lower INR (eg, 2.0-2.5) might
be reasonable in patients with UA/NSTEMI managed with ASA and a
P2Y12 inhibitor. (IIb-C)
Lipid Management
ÎÎThe following lipid recommendations are beneficial:
• Lipid management should include assessment of a fasting lipid profile for all
patients within 24 h of hospitalization. (I-C)
• In the absence of contraindications, regardless of baseline low-density
lipoprotein cholesterol (LDL-C) and diet modification, give hydroxymethyl
glutaryl-coenzyme A reductase inhibitors (statins) to post-UA/NSTEMI
patients, including post-revascularization patients. (I-A)
• For hospitalized patients, initiate lipid-lowering medications before discharge.
(I-A)
• For UA/NSTEMI patients with elevated LDL-C (≥100 mg/dL), initiate or
intensify cholesterol-lowering therapy to achieve an LDL-C of less than 100
mg/dL. (I-A) Further titration to less than 70 mg /dL is reasonable. (IIa-A)
• Therapeutic options to reduce non–high-density lipoprotein cholesterol
(non-HDL-Ca) are recommended, including more intense LDL-C–lowering
therapy. (I-B)
• Dietary therapy for all patients should include reduced intake of saturated fats
(to <7% of total calories), cholesterol (to <200 mg/d), and trans fat (to <1% of
energy). (I-B)
• Promote daily physical activity and weight management. (I-B)
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