AHA Acute Coronary Syndromes GUIDELINES Apps and Pocket Guides brought to you courtesy of Guideline Central. Enjoy!
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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.