Anti-Thrombotic Agents

The choice of antiplatelet agents is dictated by mechanical intervention. Firstly, offer fondaparinux to people with unstable angina or NSTEMI who do not have a high bleeding risk, unless they are undergoing immediate coronary angiography.

When PCI is not indicated, offer ticagrelor as part of dual antiplatelet therapy with aspirin, to people with unstable angina or NSTEMI when PCI is not indicated, unless they have a high bleeding risk. Consider clopidogrel, as part of dual antiplatelet therapy with aspirin, or aspirin alone, for people with unstable angina or NSTEMI when PCI is not indicated, if they have a high bleeding risk.

When PCI is indicated, offer systemic unfractionated heparin in the cardiac catheter laboratory to people with unstable angina or NSTEMI who are undergoing PCI whether or not they have already received fondaparinux. In patients with significant renal impairment unfractionated heparin can be used as a substitute for fondaparinux. Furthermore, offer prasugrel or ticagrelor, as part of dual antiplatelet therapy with aspirin, if they have no separate indication for ongoing oral anticoagulation.

Clopidogrel, as part of dual antiplatelet therapy with aspirin, if they have a separate indication for ongoing oral anticoagulation.