Role of anticoagulation in non-ST-elevation myocardial infarction: a contemporary narrative review.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-06-01 Epub Date: 2024-05-14 DOI:10.1080/14779072.2024.2354243
Paul Jie Wen Tern, Khung Keong Yeo, Jack Wei Chieh Tan, Chee Tang Chin, Ru San Tan, Jonathan Yap
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Abstract

Introduction: Anticoagulants play a vital role as part of the antithrombotic therapy of myocardial infarction and are complementary to antiplatelet therapies. In the acute setting, the rationale for their use is to antagonize the ongoing clotting cascade including during percutaneous coronary intervention. Anticoagulation may be an important part of the longer-term antithrombotic strategy especially in patients who have other existing indications (e.g. atrial fibrillation) for their use.

Areas covered: In this narrative review, the authors provide a contemporary summary of the anticoagulation strategies of patients presenting with NSTEMI, both in terms of anticoagulation during the acute phase as well as suggested antithrombotic regimens for patients who require long-term anticoagulation for other indications.

Expert opinion: Patients presenting with non-ST-elevation myocardial infarction (NSTEMI) should be initiated on anticoagulation (e.g. heparin/low molecular weight heparin) for the initial hospitalization period for those medically managed or until percutaneous coronary intervention. Longer term management of NSTEMI for patients with an existing indication for long-term anticoagulation should comprise triple antithrombotic therapy of anticoagulant (preferably DOAC) with aspirin and clopidogrel for up to 1 month (typically 1 week or until hospital discharge), followed by DOAC plus clopidogrel for up to 1 year, and then DOAC monotherapy thereafter.

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抗凝治疗在非 ST 段抬高型心肌梗死中的作用:当代叙述性综述。
导言:抗凝剂在心肌梗塞的抗血栓治疗中发挥着重要作用,是抗血小板疗法的补充。在急性期,使用抗凝剂的理由是为了拮抗正在发生的凝血级联反应,包括在经皮冠状动脉介入治疗期间。抗凝可能是长期抗血栓策略的一个重要组成部分,尤其是对已有其他适应症(如心房颤动)的患者:在这篇叙述性综述中,作者对 NSTEMI 患者的抗凝策略进行了当代总结,既包括急性期的抗凝,也包括针对因其他适应症而需要长期抗凝的患者所建议的抗血栓治疗方案:专家意见:非 ST 段抬高型心肌梗死(NSTEMI)患者在住院初期应开始接受抗凝治疗(如肝素/低分子量肝素),接受药物治疗或直至经皮冠状动脉介入治疗。对于已有长期抗凝适应症的 NSTEMI 患者,其长期治疗应包括抗凝剂(最好是 DOAC)联合阿司匹林和氯吡格雷的三联抗血栓治疗,疗程最长为 1 个月(通常为 1 周或直至出院),然后是 DOAC 联合氯吡格雷,疗程最长为 1 年,之后再进行 DOAC 单药治疗。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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