Aspirin acute coronary syndrome

Formulate a monitoring plan for a patient with ST-segment elevation acute coronary syndrome receiving fibrinolytics, aspirin, unfractionated heparin, intravenous nitroglycerin, intravenous (3-blockers followed by oral P-blockers, an angiotensin-converting enzyme inhibitor, and a statin. 

ACS Acute coronary syndromes ASA Aspirin (acetylsalicylic acid)... 

Acute coronary syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave Ml), initiate clopidogrel with a single 300 mg loading dose and then continue at 75 mg once daily. Initiate and continue aspirin (75 to 325 mg once daily) in combination with clopidogrel. 

Drug therapy of acute coronary syndromes including unstable angina and non-Q-wave myocardial infarction includes use of aspirin, heparin and anti-ischaemic drugs and is similar in older patients to other age groups. Activation of platelet thromboxane production in the coronary circulation has been demonstrated in unstable angina. The risk of myocardial infarction or death is reduced by approximately 50% by early aspirin therapy in recommended doses of 160-325 mg per day and continued... 

Cohen M, Adams PC, Parry G, Xiong J, Chamberlain D, Wieczorek 1 et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial. Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Circulation 1994 89(l) 81-8. 

Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001 345(7) 494-502. 

Acute coronary syndrome PO Initially, 300 mg loading dose, then 75 mg once a day (in combination with aspirin). 

Acute coronary syndrome IV Bolus, IV Infusion 180 mcg/kg bolus then 2 mcg/kg/min until discharge or coronary artery bypass graft, up to 72 hr. Maximum 15 mg/h. Concurrent aspirin and heparin therapy is recommended. 

Blazing MA, de Lemos JA, White HD, et al., for the A to Z Investigators, Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin A randomized controlled trial. JAMA 2004 292 55-64,... 

Cohen M, Theroux P Borzak S, et al. Randomized double-blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes treated with tirofiban and aspirin the ACUTE II study, The antithrombotic combination using tirofiban and enoxaparin, Am Heart J 2002 144 470-477. 

Peters R, Mehta SR, Fox KA, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003 108 1682- 1687. 

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