ABSTRACT
Acute Coronary Syndrome ■ Rupture of an atherosclerotic plaque is generally the inciting event in acute coronary syndrome
(ACS) ■ Aspirin should be given in an initial loading dose to all ACS patients and continued indefinitely
unless there is a contraindication ■ IV unfractionated heparin or subcutaneous low molecular weight heparin should be adminis-
tered in addition to antiplatelet therapy in ACS ■ In high-risk ACS patients, the use of GP IIb/IIIa inhibitor therapy should be considered ■ The addition of clopidogrel to aspirin therapy in ACS reduces the risk of adverse cardiovascular
outcomes in patients with ACS
Percutaneous Coronary Intervention (PCI) ■ High doses of aspirin have not shown increased efficacy when compared to standard doses. ■ Routine heparin has fallen out of use after PCI due to lack of efficacy. ■ Warfarin therapy in combination with aspirin results in slightly lower risk of cardiovascular
events; however, this is outweighed by increased hemorrhagic complications. ■ Pretreatment with clopidogrel 300 to 600 mg as little as two hours prior to PCI improves short-
term and long-term outcomes. ■ GP IIb/IIIa inhibitor use results in reduced 30 day and six-month mortality. ■ Evidence suggests that bivalirudin therapy is equivalent to heparin + GP IIb/IIIa inhibitor use
during PCI with less bleeding complications.
