From the Guidelines
Unstable angina requires immediate medical attention and treatment with aspirin, antiplatelet agents, anticoagulants, and beta-blockers, as well as cardiac catheterization to assess coronary artery blockages and potential revascularization procedures, such as stenting or bypass surgery, as recommended by the European Heart Journal in 2002 1.
Key Considerations
- Unstable angina is a serious cardiac condition characterized by new-onset chest pain, worsening of existing angina, or angina at rest, indicating inadequate blood flow to the heart muscle without evidence of heart cell death.
- Treatment typically involves hospitalization for close monitoring, oxygen therapy if needed, and medications including aspirin, antiplatelet agents like clopidogrel, anticoagulants such as heparin, nitroglycerin for pain relief, and beta-blockers to reduce heart workload.
- According to the European Heart Journal in 2002 1, patients with unstable angina should undergo coronary angiography as soon as possible, but without undue urgency, and may require revascularization procedures, such as percutaneous intervention or coronary bypass surgery.
- The choice of revascularization procedure depends on the extent and characteristics of the lesions, as well as the patient's overall health and risk factors, as noted in the Circulation journal in 2003 1.
Treatment Approach
- Aspirin and antiplatelet agents, such as clopidogrel, should be administered to all patients with unstable angina, unless contraindicated, as recommended by the Circulation journal in 2003 1.
- Anticoagulants, such as heparin, should be used in conjunction with antiplatelet agents to reduce the risk of thrombosis.
- Beta-blockers should be used to reduce heart workload and prevent further ischemia.
- Statins should be started to stabilize plaque and reduce the risk of further cardiovascular events.
- Cardiac catheterization should be performed to assess coronary artery blockages and potential revascularization procedures.
Risk Factor Modification
- Smoking cessation, blood pressure and diabetes control, regular exercise, and dietary changes are essential post-treatment to reduce the risk of further cardiovascular events.
- Patients should be educated on the importance of lifestyle modifications and adherence to medication regimens to improve outcomes and reduce morbidity and mortality.
- According to the European Heart Journal in 2002 1, patients with unstable angina should be closely monitored and followed up to ensure optimal management and reduce the risk of complications.
From the FDA Drug Label
Clopidogrel tablets are indicated to reduce the rate of myocardial infarction (MI) and stroke in patients with non–ST-segment elevation ACS (unstable angina [UA]/non–ST-elevation myocardial infarction [NSTEMI]), including patients who are to be managed medically and those who are to be managed with coronary revascularization Clopidogrel tablets should be administered in conjunction with aspirin.
Unstable Angina Treatment: Clopidogrel is indicated to reduce the rate of myocardial infarction and stroke in patients with unstable angina.
- The recommended dosage is a single 300 mg oral loading dose, followed by 75 mg once daily.
- It should be administered in conjunction with aspirin 2.
From the Research
Definition and Pathophysiology of Unstable Angina
- Unstable angina is a clinical syndrome characterized by increased rate and severity of angina pectoris attacks, sometimes accompanied by ECG changes similar to those seen in coronary insufficiency 3.
- The pathogenesis of unstable angina involves ruptures at points of high-grade stenosis in the epicardial coronary arteries with simultaneous apposition of thrombi and vasoconstriction, causing critical narrowing of the vascular lumen 3.
Diagnosis and Risk Stratification
- Integration of information from the history, physical exam, electrocardiogram, and cardiac biomarkers is used to formulate both the diagnosis of unstable angina and the overall assessment of patient prognosis and risk 4.
- Early diagnosis and risk stratification of patients with unstable angina enable the physician to initiate timely, appropriate treatment 4.
Treatment Options
- Pharmaceutical agents for unstable angina may be broadly grouped into one of three categories: anti-ischemic, anti-platelet, and anti-thrombotic agents 4.
- Standard therapy for unstable angina has commonly included oxygen, aspirin, nitrates, morphine, beta-blockers, and heparin 4, 5.
- Potent new anti-platelet agents, including inhibitors of platelet adenosine diphosphate and glycoprotein IIb/IIIa receptors, play important, expanding roles in the management of these syndromes 4.
- Low-molecular-weight heparins have been shown to be an effective alternative to unfractionated heparin in the treatment of unstable angina 4.
- Anticoagulant therapy, including aspirin and heparin, reduces the risk of myocardial infarction and increases survival in patients with unstable angina 6, 7.
Invasive Therapies
- Major advances in invasive techniques and devices over the last decade include revascularization with percutaneous coronary intervention and drug-eluting intracoronary stents 4.
- Coronary angiography is urgently indicated in patients with persistent symptoms, to allow the selection of PTCA or aortocoronary bypass surgery according to the findings 3.