Acute coronary syndrome: reperfusion and antithrombotic therapy
THE CONTEXT
The passage outlines acute coronary syndrome treatment, intervention after thrombolysis and the use of aspirin with a P2Y12 receptor antagonist.
Acute treatment measures
•
The treatment summary includes oxygen, cardiac rhythm monitoring and transfer to a specialist cardiology unit.
•
Listed drugs include subcutaneous fondaparinux or low-molecular-weight heparin, consideration of an intravenous nitrate infusion, oral aspirin 300 mg and a P2Y12 receptor antagonist.
•
Metoprolol is listed at 5–15 mg intravenously or 50–100 mg orally.
•
A beta-blocker should be continued only when there is evidence of left ventricular systolic dysfunction.
Intervention after thrombolysis
•
Even after successful reperfusion with thrombolysis, percutaneous coronary intervention should be considered within 24 hours to prevent recurrent infarction and improve outcome.
Aspirin
•
Oral aspirin 75–325 mg daily improves survival, with a 25% relative reduction in mortality risk.
•
The first 300 mg tablet should be given orally within the first 12 hours. Treatment should continue indefinitely if there are no side-effects.
P2Y12 receptor antagonists
•
A P2Y12 receptor antagonist should be combined with aspirin for up to 12 months.
•
The listed ticagrelor regimen is 180 mg initially, followed by 90 mg twice daily.
•
The listed prasugrel regimen is 60 mg initially, followed by 10 mg daily.
•
The listed clopidogrel regimen is 300 mg initially, followed by 75 mg daily.