Unstable angina non ST elevation myocardial infarction aspirin therapy: Difference between revisions
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| [[File:Siren.gif|30px|link=Unstable angina/ NSTEMI resident survival guide]]|| <br> || <br> | |||
| [[Unstable angina/ NSTEMI resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{Unstable angina / NSTEMI}} | {{Unstable angina / NSTEMI}} | ||
{{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; Smita Kohli, M.D. | {{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; Smita Kohli, M.D. | ||
==Overview | ==Overview== | ||
Antiplatelet therapy plays a major role in the management of [[ | Antiplatelet therapy plays a major role in the management of [[unstable angina]]/[[NSTEMI]]. This class of medication is directed towards one of the following three pathways: decreasing [[thromboxane A2]] formation ([[aspirin]]), inhibiting the P2Y12 component of the [[adenosine diphosphate]] (ADP) receptor pathway ([[thienopyridines]]) and direct inhibition of platelet aggregation ([[GP IIb/IIIa inhibitors]]). | ||
This class of medication is directed towards one of the following three pathways: decreasing [[thromboxane A2]] formation ([[ | |||
==Aspirin== | ==Aspirin== | ||
====Mechanism of Benefit==== | ====Mechanism of Benefit==== | ||
*One of the medications which has consistently been shown to reduce mortality in [[ACS]] or [[CAD]] patients is [[ | *One of the medications which has consistently been shown to reduce mortality in [[ACS]] or [[CAD]] patients is [[aspirin]]. | ||
====Clinical Trial Data==== | ====Clinical Trial Data==== | ||
Until recently, no trial had directly compared the efficacy of different doses of ASA in patients who present with [[ | Until recently, no trial had directly compared the efficacy of different doses of ASA in patients who present with [[unstable angina]]/[[NSTEMI]]. | ||
*[[Double dose Clopidogrel associated with improved cardiac outcomes in patients undergoing PCI: Results of CURRENT/OASIS-7 Trial|CURRENT OASIS 7 trial]], which was a randomized, multicenter, multinational trial enrolling 25,087 patients with [[ACS]] showed no difference in cardiovascular outcomes of death from [[MI]] or [[stroke]] between low dose [[aspirin]] (75-100mg) compared to high dose aspirin (300-325mg) at the end of 30 days. | *[[Double dose Clopidogrel associated with improved cardiac outcomes in patients undergoing PCI: Results of CURRENT/OASIS-7 Trial|''CURRENT OASIS 7'' trial]], which was a randomized, multicenter, multinational trial enrolling 25,087 patients with [[ACS]] showed no difference in cardiovascular outcomes of death from [[MI]] or [[stroke]] between low dose [[aspirin]] (75-100mg) compared to high dose aspirin (300-325mg) at the end of 30 days. | ||
*The Second International Study of Infarct Survival (ISIS-2) trial<ref name="pmid2899772">{{cite journal |author= |title=Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group |journal=[[Lancet]] |volume=2 |issue=8607 |pages=349–60 |year=1988 |month=August |pmid=2899772 |doi= |url= |accessdate=2011-04-12}}</ref> led to the recommendation that [[ASA]] be initiated immediately in the | *The Second International Study of Infarct Survival (ISIS-2) trial<ref name="pmid2899772">{{cite journal |author= |title=Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group |journal=[[Lancet]] |volume=2 |issue=8607 |pages=349–60 |year=1988 |month=August |pmid=2899772 |doi= |url= |accessdate=2011-04-12}}</ref> led to the recommendation that [[ASA]] be initiated immediately in the emergency room once the diagnosis of [[ACS]] is made or suspected. Aspirin therapy can also be initiated in the prehospital setting when [[ACS]] is suspected. | ||
* | *In regards to safety (e.g., gastrointestinal bleeding), a few large observational studies have found that the rate of bleeding appears to be lower with low-dose [[aspirin]] (75-100mg daily) when compared with high dose aspirin (325 mg daily) in patients receiving medical therapy, percutaneous coronary intervention ([[PCI]]) or coronary artery bypass grafting ([[CABG]]). | ||
====Dosing==== | ====Dosing==== | ||
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*On the basis of previous randomized trials, the current recommendation for initial dose of [[aspirin]] is 162-325mg. | *On the basis of previous randomized trials, the current recommendation for initial dose of [[aspirin]] is 162-325mg. | ||
*After an initial loading dose of 162 to 325 mg, a dose of 75 to 100mg daily appears sufficient. | *After an initial loading dose of 162 to 325 mg, a dose of 75 to 100mg daily appears sufficient. | ||
*On the basis of current available data, lifelong continuation of aspirin should be encouraged unless | *On the basis of current available data, lifelong continuation of aspirin should be encouraged unless contraindicated. | ||
*In patients who have an allergy or who cannot tolerate [[aspirin]], use of [[clopidogrel]] is recommended. | *In patients who have an allergy or who cannot tolerate [[aspirin]], use of [[clopidogrel]] is recommended. | ||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
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[[Category:Ischemic heart diseases]] | [[Category:Ischemic heart diseases]] | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Mature chapter]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Best pages]] | |||
Latest revision as of 21:15, 5 December 2022
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Resident Survival Guide |
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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to Hospitals Treating Unstable angina non ST elevation myocardial infarction aspirin therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.
Overview
Antiplatelet therapy plays a major role in the management of unstable angina/NSTEMI. This class of medication is directed towards one of the following three pathways: decreasing thromboxane A2 formation (aspirin), inhibiting the P2Y12 component of the adenosine diphosphate (ADP) receptor pathway (thienopyridines) and direct inhibition of platelet aggregation (GP IIb/IIIa inhibitors).
Aspirin
Mechanism of Benefit
- One of the medications which has consistently been shown to reduce mortality in ACS or CAD patients is aspirin.
Clinical Trial Data
Until recently, no trial had directly compared the efficacy of different doses of ASA in patients who present with unstable angina/NSTEMI.
- CURRENT OASIS 7 trial, which was a randomized, multicenter, multinational trial enrolling 25,087 patients with ACS showed no difference in cardiovascular outcomes of death from MI or stroke between low dose aspirin (75-100mg) compared to high dose aspirin (300-325mg) at the end of 30 days.
- The Second International Study of Infarct Survival (ISIS-2) trial[1] led to the recommendation that ASA be initiated immediately in the emergency room once the diagnosis of ACS is made or suspected. Aspirin therapy can also be initiated in the prehospital setting when ACS is suspected.
- In regards to safety (e.g., gastrointestinal bleeding), a few large observational studies have found that the rate of bleeding appears to be lower with low-dose aspirin (75-100mg daily) when compared with high dose aspirin (325 mg daily) in patients receiving medical therapy, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
Dosing
- Non enteric coated formulations are preferred due to rapid buccal absorption.
- On the basis of previous randomized trials, the current recommendation for initial dose of aspirin is 162-325mg.
- After an initial loading dose of 162 to 325 mg, a dose of 75 to 100mg daily appears sufficient.
- On the basis of current available data, lifelong continuation of aspirin should be encouraged unless contraindicated.
- In patients who have an allergy or who cannot tolerate aspirin, use of clopidogrel is recommended.
References
- ↑ "Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group". Lancet. 2 (8607): 349–60. 1988. PMID 2899772. Unknown parameter
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