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Table 18. Special Patient Groups (cont'd)
Recommendations
COR LOE
Perioperative NSTE-ACS related to noncardiac surgery
Patients who develop NSTE-ACS following noncardiac surgery
should receive GDMT as recommended for patients in the general
population but with the modifications imposed by the specific
noncardiac surgical procedure and the severity of NSTE-ACS.
I C
In patients who develop NSTE-ACS aer noncardiac surgery,
management should be directed at the underlying cause.
I C
CKD
CrCl should be estimated in patients with NSTE-ACS, and doses
of renally cleared medications should be adjusted according to the
pharmacokinetic data for specific medications.
I B
Patients undergoing coronary and LV angiography should receive
adequate hydration.
I C
An invasive strateg y is reasonable in patients with mild (stage 2)
and moderate (stage 3) CKD.
IIa B
Women
Women with NSTE-ACS should be managed with the same
pharmacological therapy as that for men for acute care and for
secondary prevention, with attention to weight and/or renally-
calculated doses of antiplatelet and anticoagulant agents to reduce
bleeding risk.
I B
Women with NSTE-ACS and high-risk features (e.g., troponin
positive) should undergo an early invasive strateg y.
I A
Myocardial revascularization is reasonable in pregnant women
with NSTE-ACS if an ischemia-guided strateg y is ineffective for
management of life-threatening complications.
IIa C
Women with NSTE-ACS and low-risk features should NOT
undergo early invasive treatment because of the lack of benefit and
the possibility of harm.
III: No
Benefit
B
Anemia, bleeding, and transfusion
All patients with NSTE-ACS should be evaluated for the risk of
bleeding.
I C
Anticoagulant and antiplatelet therapy should be weight-based
where appropriate and should be adjusted when necessary for CKD
to decrease the risk of bleeding in patients with NSTE-ACS.
I B
A strateg y of routine blood transfusion in hemodynamically stable
patients with NSTE-ACS and hemoglobin levels >8 g/dL is NOT
recommended.
III: No
Benefit
B
