From the Guidelines
The management of unstable angina requires immediate hospitalization and a comprehensive treatment approach, with a focus on reducing morbidity, mortality, and improving quality of life. The goal of treatment is to relieve symptoms, prevent progression to myocardial infarction, and reduce the risk of death.
- Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor such as ticagrelor or clopidogrel is recommended, as it has been shown to reduce the risk of death and myocardial infarction in patients with unstable angina 1.
- Anticoagulation with unfractionated heparin, low molecular weight heparin, or fondaparinux should be initiated to reduce the risk of thrombus formation and progression to myocardial infarction 1.
- High-intensity statin therapy is recommended regardless of baseline cholesterol levels, as it has been shown to reduce the risk of death and myocardial infarction in patients with unstable angina 1.
- Symptom relief includes sublingual nitroglycerin, intravenous nitroglycerin for persistent pain, and beta-blockers to reduce myocardial oxygen demand 1.
- Early invasive strategy with coronary angiography within 24-48 hours is recommended for most patients, with timing based on risk stratification, as it has been shown to reduce the risk of death and myocardial infarction in high-risk patients 1. Key considerations in the management of unstable angina include:
- Risk stratification to identify patients at high risk for progression to myocardial infarction or death
- Early initiation of antiplatelet and anticoagulant therapy
- Use of high-intensity statin therapy to reduce the risk of death and myocardial infarction
- Symptom relief with nitrates, beta-blockers, and morphine as needed
- Early invasive strategy with coronary angiography and revascularization as indicated.
From the FDA Drug Label
In patients who received transfusions, the corresponding loss in hemoglobin was estimated through an adaptation of the method of Landefeld et al. If angina markedly worsens or acute coronary insufficiency develops, metoprolol administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken.
- Management of Unstable Angina: The management of unstable angina may involve the use of medications such as eptifibatide and metoprolol.
- Eptifibatide: Eptifibatide is used to prevent platelet aggregation and is often used in patients undergoing percutaneous coronary intervention (PCI) 2.
- Metoprolol: Metoprolol is a beta-blocker that can be used to manage angina, but it should not be abruptly discontinued in patients with coronary artery disease, as this can lead to severe exacerbation of angina or myocardial infarction 3.
- Key Considerations: When managing unstable angina, it is essential to carefully monitor patients and adjust treatment as needed to prevent complications such as bleeding or worsening angina.
From the Research
Management of Unstable Angina
The management of unstable angina involves a combination of medical therapy, invasive procedures, and lifestyle modifications. The primary goals of treatment are to reduce the risk of myocardial infarction and death, alleviate symptoms, and improve quality of life.
Medical Therapy
- Antiplatelet agents, such as aspirin 4, are used to reduce the risk of myocardial infarction and death.
- Anticoagulants, such as heparin 5, 4, are used to prevent thrombus formation.
- Anti-ischemic agents, such as nitrates 6, 4 and beta-blockers 6, 4, are used to reduce myocardial oxygen demand and alleviate symptoms.
- Glycoprotein IIb/IIIa inhibitors 5, 4 may be used in high-risk patients with refractory unstable angina and elevated troponin levels.
Invasive Procedures
- Coronary angiography 5, 7, 8 is used to diagnose and treat coronary artery disease.
- Percutaneous transluminal coronary angioplasty (PTCA) 5, 7 and coronary artery bypass grafting (CABG) 5, 7, 6 may be used to treat significant coronary artery stenosis.
- An invasive strategy, which includes early coronary angiography and revascularization, may be beneficial in reducing the risk of fatal or nonfatal re-infarction and hospital readmission 8.
Risk Stratification
- Risk stratification is crucial in identifying patients who are at high risk of early progression to myocardial infarction and death 5.
- Biochemical markers of myocardial injury, such as troponin-T and troponin-I 5, may be used in combination with electrocardiographic findings and clinical features to stratify risk.