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ANTITHROMBOTIC

THERAPY IN ACUTE
CORONARY SYNDROME
Budi Yuli Setianto, MD, PhD, FINASIM, FIHA, FAsCC,
FAPSIC

Department of Cardiology and Vascular Medicine


Faculty of Medicine Gadjah Mada University – Sardjito
Hospital Yogyakarta
Acute
Coronary
Syndromes
Summary of Recommendations for Early Hospital Care

J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017


*Short-acting dihydropyridine calcium channel antagonists should be avoided.

J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017


Summary of Recommendations for
Prognosis: Early Risk Stratification

J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017


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TIMI Risk Score UA / NSTEMI


HISTORICAL POINTS RISK OF CARDIAC EVENTS (%)
Age  65 1 BY 14 DAYS IN TIMI 11B*
RISK DEATH DEATH, MI OR
 3 CAD risk factors
(FHx, HTN,  chol, DM, active smoker) 1 SCORE OR MI URGENT REVASC

Known CAD (stenosis  50%) 1 0/1 3 5


ASA use in past 7 days 1 2 3 8
PRESENTATION 3 5 13
Recent ( 24H) severe angina 1 4 7 20
 cardiac markers 1 5 12 26
ST deviation  0.5 mm 1 6/7 19 41
RISK SCORE = Total Points (0 - 7)
* Entry criteria:UA or NSTEMI defined as ischemic pain
Low = 0-2 points, Medium = 3-4 points
at rest within past 24H, with evidence of CAD (ST segment
High = 5-7 points deviation or +marker)
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Algorithm for Management of Patients With Definite or
Likely NSTE-ACS*
Factors Associated With Appropriate Selection
of Early Invasive Strategy or Ischemia-Guided
Strategy in Patients With NSTE-ACS
Summary of Recommendations for Initial
Antiplatelet/Anticoagulant Therapy in Patients With
Definite or Likely NSTE-ACS and PCI
*The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily
Dosing of Parenteral Anticoagulants During
PCI
*CrCl should be calculated for all older pts because SCr level does not accurately reflect renal dysfunction: CrCl decreases with age
0.7 mL/min/y. †These agents are not approved for NSTE-ACS but are included for management of pts with nonvalvular chronic atrial
fibrillation.
Conclusion
• ACS is divided into STEMI and NSTE-ACS
• The new paradigm of management of NSTE-ACS is
early invasive strategy
• Early risk stratification is important for NSTE-ACS
prognosis
• Early invasive strategy (PCI) require different
antithrombotic treatment strategies
• Antithrombotic agents composed DAPT and
parenteral anticoagulants