For Unstable Angina how long do you keep Plavix

[Cadet133]

For patients with NSTEMI who the cardiologist wants to do conservative management how long do you keep them on ASA + Plavix assuming they did not get a stent?

What about for patients with unstable angina who undergo cath which shows some disease but not requiring stent. How long do you continue ASA + Plavix?

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[Rocher]

For patients with NSTEMI who the cardiologist wants to do conservative management how long do you keep them on ASA + Plavix assuming they did not get a stent?

What about for patients with unstable angina who undergo cath which shows some disease but not requiring stent. How long do you continue ASA + Plavix?

ACC/AHA guidelines recommend DAPT for at least 12 months in patients with NSTEMI/UA treated with medical management (class I recommendation). You can download the acc/aha guideline app which can be helpful for questions like this on the fly.

 

[IMreshopeful]

For patients with NSTEMI who the cardiologist wants to do conservative management how long do you keep them on ASA + Plavix assuming they did not get a stent?

What about for patients with unstable angina who undergo cath which shows some disease but not requiring stent. How long do you continue ASA + Plavix?

1 year for an acute coronary syndrome irrespective of stent or no stent/type of stent. The data from CURE was mostly NSTEMI with troponin elevation. The trouble with CURE is that there was a pretty low proportion of patients who actually got revascularized compared to the general clinical population (~30%) and its a pretty old trial, so lots of the newer generation stents may not require as prolonged DAPT

If unstable angina and no obstructive lesion, the data is more murky. If there’s no plaque to stabilize then the benefit is unclear (also you question to what degree your angina was actually angina). This is more physician and patient choice IMO

 

[AG MD]

I know this post was made last year but I also have a question about something similar. Is NSTEMI/UA management the same? like if you give the recommended meds and then depending on whether the chest pain is still there after the meds then do a cath? And then I read that you should do a cath on high risk patients. Is that if they have a lot of the risk factors like hypertension, diabetes etc?
Basically when do we do a cath on someone who has an NSTEMI/UA? Because on uworld CCS theres a person with unstable angina and he gets better after all the meds but uworld still says to do a cath and angioplasty... I'm getting confused. Any help would be appreciated!

 

[gutonc]

I know this post was made last year but I also have a question about something similar. Is NSTEMI/UA management the same? like if you give the recommended meds and then depending on whether the chest pain is still there after the meds then do a cath? And then I read that you should do a cath on high risk patients. Is that if they have a lot of the risk factors like hypertension, diabetes etc?
Basically when do we do a cath on someone who has an NSTEMI/UA? Because on uworld CCS theres a person with unstable angina and he gets better after all the meds but uworld still says to do a cath and angioplasty... I'm getting confused. Any help would be appreciated!

You should definitely do the cath if they have good insurance and your boat payment is due.

Otherwise, medical management is appropriate.

Outcomes are the same.

PS...this will not help you on Step 3. "Boat payment due" is never going to be the answer on the test, even if it's the answer in real life.

 

[IMreshopeful]

I know this post was made last year but I also have a question about something similar. Is NSTEMI/UA management the same? like if you give the recommended meds and then depending on whether the chest pain is still there after the meds then do a cath? And then I read that you should do a cath on high risk patients. Is that if they have a lot of the risk factors like hypertension, diabetes etc?
Basically when do we do a cath on someone who has an NSTEMI/UA? Because on uworld CCS theres a person with unstable angina and he gets better after all the meds but uworld still says to do a cath and angioplasty... I'm getting confused. Any help would be appreciated!

You cath those patients who have chest pain as a result of UA/NSTEMI because we have lots of data showing that early (but not acutely early) revascularization helps these patients from a symptom and mortality perspective. Even if they’re stabilized on meds it decreases risk of issues in the future. There are certain populations who do not fare as well (younger women for example) and could make argument for conservative therapy in select cases but generally you want to revascularize

Now obviously if the patient has a trop I of 0.2 in setting of multiorgan failure due to sepsis, this is not appropriate to cath

 

[AG MD]

Thank you for your replies! I appreciate it a lot.