NSTEMI and Unstable Angina

NSTEMI and unstable angina: Early Management

All patients diagnosed with UA or NSTEMI should be given 300 mg aspirin (unless clear evidence of allergy) and those who are clinically unstable should proceed to immediate coronary angiography +/- PCI.

SC Fondaparinux 2.5mg stat (unless they are for immediate pPCI or at high bleeding risk or renal impairment Cr >265 µmol/L), use unfractionated heparin in case of AKI or planned immediate pPCI

Calculate risk: GRACE sore (estimate six-month mortality risk)

NICE NSTEMI/unstable angina guidelines are based on 6 month mortality risk:

• if > 1.5% clopidogrel for 12 months
• if > 3% angiography ± PCI within 96 hours

For those undergoing PCI, unfractionated heparin should be given regardless of whether the patient has had fondaparinux or not

Give second antiplatelet if undergoing angiography ± PCI: either 60 mg prasugrel or 180 mg ticagrelor unless on a regular oral anticoagulant, in which case they should be given 300 mg of clopidogrel

Prasugrel to commence at Cathlab after coronary anatomy has been defined (due to high bleeding risk)

Not for pPCI => ticagrelor