What are the AHA/ACC guidelines on antiplatelet/anticoagulation for acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
  • Print
Answer

The 2014 AHA/ACC recommendations for initial antiplatelet/anticoagulation therapy in patients with NSTE-ACS are summarized below. [112]

Aspirin

Non–enteric-coated, chewable aspirin (162 mg to 325 mg) should be given to all patients without contraindications as soon as possible after presentation, and a maintenance dose of aspirin (81 mg/d to 325 mg/d) should be continued indefinitely. (Class I; level of evidence A) 

In patients who are unable to take aspirin because of hypersensitivity or major gastrointestinal (GI) intolerance, administer a loading dose of clopidogrel followed by a daily maintenance dose. (Class I; level of evidence B) 

Anticoagulation

Administer anticoagulation, in addition to antiplatelet therapy, for all patients, irrespective of the initial treatment strategy. Treatment options include the following (all Class I):

  • Subcutaneous (SC) enoxaparin for the duration of hospitalization or until PCI is performed (Level of evidence: A)  
  • Bivalirudin until diagnostic angiography or PCI is performed in patients with early invasive strategy only (Level of evidence: B)
  • SC fondaparinux for the duration of hospitalization or until PCI is performed (Level of evidence: B)
  • IV unfractionated heparin (UFH) for 48 h or until PCI is performed (Level of evidence: B)

IV fibrinolytic treatment is not recommended in patients with NSTE-ACS. (Class III, level of evidence: A)


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!