Unstable angina non ST elevation myocardial infarction long term anticoagulation therapy: Difference between revisions
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'''Clinical Trial Data:''' | '''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. | *'''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. | ||
==Related Chapters== | ==Related Chapters== |
Revision as of 21:12, 3 December 2012
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.
Related Chapters
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [2]
References
- ↑ van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE (2002). "Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial". Lancet. 360 (9327): 109–13. doi:10.1016/S0140-6736(02)09409-6. PMID 12126819. Unknown parameter
|month=
ignored (help) - ↑ Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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ignored (help)
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