الفهرس 
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Abstract
The term acute coronary syndrome( ACS) is used to cover
a group of clinical symptoms compatible with acute myocardial
ischemia that result from coronary artery diseases.These include
unstable angina (UA) and the closely related non–ST-segment
elevation myocardial infarction (NSTEMI), which are associated
with an increased risk of death and myocardial infarction (MI);
and ST-segment elevation myocardial infarction (STEMI).
The course of recovery in (ACS) involves spontaneous,
mechanical, or pharmacologic thrombolysis. Clot lysis is
associated with hypercoagulability, as thrombin molecules are
exposed during the process. This sets the stage for recurrent
thrombosis and possible vessel reocclusion.For this reason,
anticoagulant therapy is critical during the acute phase of
treatment.
In patients with non-ST elevation acute coronary
syndrome (ACS), which includes unstable angina and non-ST
elevation myocardial infarction (NSTEMI) anticoagulant
therapy is made for patients irrespective of whether an invasive
or a conservative approach is taken. Anticoagulant therapy
should be given as soon as possible after diagnosis and should
be given in conjunction with recommended antiplatelet
therapy.For patients managed with an early invasive strategy
Summary
83
(angiography within 4 to 48 hours), suggestion with bivalirudin
or unfractionated (UFH) as opposed to enoxaparin or to
fondaparinux When fondaparinux is chosen, (UFH) (or
bivalirudin) should be given before percutaneous coronary
intervention.
For patients who will be referred to the catheterization
laboratory within four hours (usually due to patient instability
for reasons such as refractory angina, heart failure, arrhythmia,
or hemodynamic instability), suggestion with (UFH) or
bivalirudin as opposed to fondaparinux or enoxaparin.
For patients in whom a conservative (non-invasive)
strategy is planned,recommend either fondaparinux or
enoxaparin in preference to either unfractionated heparin or
bivalirudin .
The choice between fondaparinux and enoxaparin should
be guided by issues of cost and local practice. For patients at
higher risk of bleeding , fondaparinux is suggested.
All patients with ST-elevation myocardial infarction
(STEMI) should receive anticoagulation. Irrespective of the
reperfusion strategy, anticoagulant therapy should be given as
soon as possible after diagnosis. In addition, all patients with
(STEMI) should receive dual antiplatelet therapy.
For all patients treated with primary percutaneous
coronary intervention, anticoagulant therapy is recommended.
Summary
84
Recommendation with either bivalirudin (with provisional
glycoprotein [GP] IIb/IIIa inhibitor incases of ischemic
complications or large thrombus burden) or a heparin (and
planned GP IIb/IIIa inhibitor) in preference to fondaparinux.
Suggestion with bivalirudin in preference to a heparin
(used in conjunction with a GP IIb/IIIa inhibitor). This
recommendation takes into account the opposing outcomes of
major bleeding and stent thrombosis, as well as equivalent or
better mortality with bivalirudin.
For patients in whom bivalirudin will not be chosen,
enoxaparin, is a reasonable alternative to (UFH) for patients
undergoing( PCI) .
For patientstreated with fibrinolytic therapy, anticoagulant
therapy is recommended .
For patients not at high risk of bleeding, suggesstion using
enoxaparin as opposed to( UFH), fondaparinux, or bivalirudin.
For those patients in whom (PCI) is possible or likely after
fibrinolytic therapy, (UFH) is a reasonable choice.
For patients at high risk of a bleeding complication and
who are not likely to require (PCI), suggestion with
fondaparinux as opposed to enoxaparin or (UFH).
For patients not treated with reperfusion therapy,
suggestion with anticoagulant therapy with enoxaparin ,(UFH)
or fondaparinux, as opposed to no anticoagulant therapy, as soon
as possible after presentation.