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Unstable Angina and NSTEMIs: Management Principles. Meira Louis Lisa Campfens. Outline. Pick your/ cardio’s strategy Initial therapy...for everyone? Pick an anti-platelet...or two...or three... Protect the stomach??? PPI controversy Pick the right anti-coagulant

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Presentation Transcript
outline
Outline
  • Pick your/cardio’s strategy
  • Initial therapy...for everyone?
  • Pick an anti-platelet...or two...or three...
  • Protect the stomach??? PPI controversy
  • Pick the right anti-coagulant
  • Send home the lucky stable one
anti coagulants
Anti-Coagulants
  • Indirect inhibitors of coagulation (need antithrombin for their full action)
    • Indirect thrombin inhibitors: UFH; LMWHs
    • Indirect factor Xa inhibitors: LMWHs; fondaparinux
  • Direct inhibitors of coagulation
    • Direct factor Xa inhibitors: apixaban, rivaroxaban, otamixaban
    • Direct thrombin inhibitors (DTIs): bivalirudin, dabigatran
take home points
Take Home Points
  • Initial therapy for everyone
    • think ASA and nitrates
    • Be careful with BB, CCB, morphine
    • Consider ace inhibitors
  • Pick an anti-platelet...or two...or three...
    • Plavix in everyone at 300mg
    • Talk to cardio about prasugrel or ticagrelor
    • Leave the GPI until they go to PCI
  • Protect the stomach!
    • PPIs show more benefit than harm
  • Pick an anti-coagulant
    • UFH if high risk or going to CABG
    • Enox or Bivalirudin if going to PCI
    • Fonda if conservative strategy or high risk for bleeding
  • For the ones sent home...
    • ASA and Plavix for at least 1 month
    • Stress test within 72 hours