Unstable angina non ST elevation myocardial infarction long term anticoagulation therapy: Difference between revisions
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| [[File:Siren.gif|30px|link=Acute coronary syndrome intern survival guide]]|| <br> || <br> | |||
| [[Acute coronary syndrome intern survival guide|Intern <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. | ||
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[[Warfarin]] is the typical drug used for long term anticoagulation. However, its role, if any, in patients with [[UA]]/[[NSTEMI]] has not been clearly defined. | [[Warfarin]] is the typical drug used for long term anticoagulation. However, its role, if any, in patients with [[UA]]/[[NSTEMI]] has not been clearly defined. | ||
====Clinical Trial Data==== | |||
''ASPECT 2'' trial<ref name="pmid12126819">{{cite journal |author=van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE |title=Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial |journal=Lancet |volume=360 |issue=9327 |pages=109–13 |year=2002 |month=July |pmid=12126819 |doi=10.1016/S0140-6736(02)09409-6 |url=}}</ref> showed that in patients recently admitted with [[ACS]], treatment with high-intensity oral anticoagulants or [[aspirin]] with medium-intensity oral anticoagulants was more effective than aspirin alone in reduction of subsequent cardiovascular events and death. However, similar benefit is seen with [[clopidogrel]] plus aspirin over aspirin alone, the lack of need for monitoring of the [[INR]], and the frequent use of [[PCI]] and stenting in the patient population in whom the need for clopidogrel is well established, the clinical use of aspirin plus warfarin is limited. Among patients without a coronary stent but with another indication for warfarin, such as chronic [[atrial fibrillation]], mechanical valve or severe [[left ventricular dysfunction]] who are at high risk of systemic [[embolization]], the combination of aspirin plus warfarin would be preferable as the long-term antithrombotic strategy. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Ischemic heart diseases]] | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | |||
[[Category:Mature chapter]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Needs overview]] | |||
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{{WS}} | {{WS}} |
Latest revision as of 21:14, 5 December 2022
Intern Survival Guide |
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
Special Groups |
Diagnosis |
Laboratory Findings |
Treatment |
Antitplatelet Therapy |
Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
Mechanical Reperfusion |
Discharge Care |
Case Studies |
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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.
Long Term Anticoagulation
Warfarin is the typical drug used for long term anticoagulation. However, its role, if any, in patients with UA/NSTEMI has not been clearly defined.
Clinical Trial Data
ASPECT 2 trial[1] showed that in patients recently admitted with ACS, treatment with high-intensity oral anticoagulants or aspirin with medium-intensity oral anticoagulants was more effective than aspirin alone in reduction of subsequent cardiovascular events and death. However, similar benefit is seen with clopidogrel plus aspirin over aspirin alone, the lack of need for monitoring of the INR, and the frequent use of PCI and stenting in the patient population in whom the need for clopidogrel is well established, the clinical use of aspirin plus warfarin is limited. Among patients without a coronary stent but with another indication for warfarin, such as chronic atrial fibrillation, mechanical valve or severe left ventricular dysfunction who are at high risk of systemic embolization, the combination of aspirin plus warfarin would be preferable as the long-term antithrombotic strategy.