Acute coronary syndrome medications

[fernandbteich]

Hello
I have two questions about acute coronary syndromes. I can't find answers online.
1- If a person known to have CAD is already on Aspirin+/-Clopidogrel (with previous cardiac events), and develops acute coronary syndrome, do we reload the patient with 325mg of Aspirin and 300mg of Clopidogrel or just continue maintenance doses?

2- If a person presents with NSTEMI and a coronarography is planned less than 12 hours later, is it recommended to give a continuous infusion of heparin in addition to the 80IU/kg bolus?

Thank you

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[staup640]

1) Give 325 ASA, don't reload Plavix 2) Not sure what the official recs are, some interventional guys like different things, in general give the continuous infusion and bolus.

 

[happymedgrad]

Interesting. I'd be a lot more comfortable reloading both, and if I had to choose one it would be plavix. I'd assume either noncompliance or plavix resistance and would definitely give a top up 300.

Ultimately switch to ticagrelor (or maybe prasugrel in a younger diabetic).

Re: heparin bolus and infusion sounds fine.

 

[staup640]

I'm an internist, not a cardiologist, and in my residency ~5 yrs ago we didn't reload plavix. The thinking was the half life is so long reloading is not needed. I just looked it up and found a study from 2013 citing a clinical benefit for reloading, so... reload!

 

[Instatewaiter]

Hello
I have two questions about acute coronary syndromes. I can't find answers online.
1- If a person known to have CAD is already on Aspirin+/-Clopidogrel (with previous cardiac events), and develops acute coronary syndrome, do we reload the patient with 325mg of Aspirin and 300mg of Clopidogrel or just continue maintenance doses?

2- If a person presents with NSTEMI and a coronarography is planned less than 12 hours later, is it recommended to give a continuous infusion of heparin in addition to the 80IU/kg bolus?

Thank you

Agree.

Reload (and probably switch to ticagrellor... not exactly a bunch of indications to use prasugrel over ticagrellor)

Bolus + infusion of heparin even if going right to cath lab. We'll turn it off and check an ACT once we get access regardless.