Antiplatelet Therapy in Patients with Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction: Findings from the CRUSADE National Quality Improvement Initiative

Michael B. Bottorff, Pharm.D.; Edith A. Nutescu, Pharm.D.; Sarah Spinler, Pharm.D.

Disclosures

Pharmacotherapy. 2007;27(8):1145-1152. 

In This Article

The ACC-AHA Guideline Recommendations

The ACC-AHA unstable angina and NSTEMI guideline recommendations with respect to early interventions and discharge drug therapies are summarized in Table 2 ,[4] along with recently updated recommendations from the ACC-AHA for secondary prevention in patients with coronary heart disease.[31] The recommendations for use of antiplatelet agents in unstable angina and NSTEMI in both early intervention and discharge situations are supported by large-scale randomized trials.[32–39] In brief, early interventions recommended by the guidelines include the antiplatelet agents aspirin, clopidogrel, and glycoprotein (GP) IIb-IIIa inhibitors; heparin (unfractionated or low-molecular-weight); β-blockers; and ACE inhibitors. Discharge therapies include aspirin, clopidogrel, β-blockers, ACE inhibitors or angiotensin II receptor blockers for patients with myocardial infarction and a left ventricular ejection fraction of 40% or less, and lipid-lowering agents. Lifestyle modification, including smoking-cessation counseling and dietary modification, is also recommended at discharge. Combinations of evidence-based medical therapies have been associated with a reduction of the 6-month mortality rate in patients with ACS.[40]

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