Treatment
20
Table 16. Late Hospital Care, Hospital Discharge, and
Posthospital Discharge Care
Recommendations
COR LOE
Medical regimen and use of medications at discharge
Medications required in the hospital to control ischemia should
be continued aer hospital discharge in patients with NSTE-ACS
who do not undergo coronary revascularization, patients with
incomplete or unsuccessful revascularization, and patients with
recurrent symptoms aer revascularization. Titration of the doses
may be required.
I C
All patients who are post−NSTE-ACS should be given sublingual
or spray nitroglycerin with verbal and written instructions for its
use.
I C
Before hospital discharge, patients with NSTE-ACS should be
informed about symptoms of worsening myocardial ischemia and
MI and should be given verbal and written instructions about how
and when to seek emergency care for such symptoms.
I C
Before hospital discharge, patients who are post−NSTE-ACS and/
or designated responsible caregivers should be provided with easily
understood and culturally sensitive verbal and written instructions
about medication type, purpose, dose, frequency, side effects, and
duration of use.
I C
For patients who are post−NSTE-ACS and have initial angina
lasting >1min, nitroglycerin (1 dose sublingual or spray) is
recommended if angina does not subside within 3-5 min; call 9-1-1
immediately to access emergency medical services.
I C
If the pattern or severity of angina changes, suggesting worsening
myocardial ischemia (e.g., pain is more frequent or severe or is
precipitated by less effort or occurs at rest), patients should contact
their clinician without delay to assess the need for additional
treatment or testing.
I C
Before discharge, patients should be educated about modification
of cardiovascular risk factors.
I C
Late hospital and posthospital oral antiplatelet therapy
ASA should be continued indefinitely. e maintenance dose
should be 81 mg daily in patients treated with ticagrelor and 81-
325 mg daily in all other patients.
I A
In addition to ASA, a P2Y
12
inhibitor (either clopidogrel or
ticagrelor) should be continued for ≤12 months in all patients with
NSTE-ACS without contraindications who are treated with an
ischemia-guided strateg y. Options include:
• Clopidogrel: 75 mg daily or
• Ticagrelor:
a
90 mg twice daily
I B
a
e recommended maintenance dose of ASA to be used with ticagrelor is 81 mg daily.
