From the Guidelines
For a patient with unstable angina who has undergone ACS protocol activation and is currently on aspirin, fondaparinux, and ticagrelor, the NHS discharge medications should include aspirin 81mg daily indefinitely and ticagrelor 90mg twice daily is not recommended, instead ticagrelor 81 mg daily for up to 12 months. The discharge orders will be based on the latest guidelines for the management of patients with non-ST-elevation acute coronary syndromes, as per the 2014 AHA/ACC guideline 1. The patient is already on aspirin, which should be continued indefinitely at a dose of 81mg daily, as high-dose aspirin is associated with increased bleeding risk without improved outcomes 1. Ticagrelor should be continued at a dose of 81 mg daily for up to 12 months, as it is a P2Y12 inhibitor that has been shown to be effective in reducing cardiac events in patients with NSTE-ACS 1. Fondaparinux would be discontinued at discharge as it's primarily used during the acute hospital phase. Additional medications that may be considered for discharge include a high-intensity statin, an ACE inhibitor, and a beta-blocker, which work together to prevent further cardiac events by reducing cholesterol levels, cardiac workload, and providing cardioprotective effects. Key points to consider when discharging the patient include:
- Aspirin 81mg daily indefinitely
- Ticagrelor 81 mg daily for up to 12 months
- Discontinuation of fondaparinux
- Consideration of additional medications such as statins, ACE inhibitors, and beta-blockers
- Lifestyle modification advice regarding smoking cessation, diet, exercise, and stress management
- Follow-up appointments for cardiac rehabilitation and medication review within 1-2 weeks of discharge.
From the Research
Discharge Medications for Unstable Angina
The patient is currently on aspirin, fondaparinux, and ticagrelor. As per the NHS guidelines and evidence from studies 2, 3, the discharge medications for a patient with unstable angina may include:
- Aspirin: as the foundation antiplatelet agent
- Ticagrelor: a P2Y12 inhibitor, which is recommended for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS)
- Fondaparinux: an anticoagulant, which may be used in specific settings
Considerations for Discharge Orders
When considering discharge orders, the following points should be taken into account:
- The patient's current medication regimen, including aspirin, fondaparinux, and ticagrelor
- The need for ongoing antiplatelet and anticoagulation therapy to reduce the risk of further cardiac events
- The potential for bleeding complications and the need to balance the benefits and risks of antithrombotic therapy 3
- The importance of patient education on risk reduction and medication adherence 2
Additional Therapies
Other therapies that may be considered for patients with unstable angina include:
- Beta-blockers: which may be used to reduce mortality and morbidity in patients with stable angina, but their use in unstable angina is not well established 4
- Other anti-anginal agents: such as nitrates, calcium-channel blockers, and ivabradine, which may be used to manage symptoms and reduce the risk of further cardiac events 5