Initial NSTEMI Management

Handout on initial management of NSTEMI by Dr Karee Byram for FMTS.  (Sorry for the print quality and sideways orientation.)

Of note, atenolol IS a cardioselective beta-blocker, but loses its cardioselectivity at lower doses than metoprolol (which is cardioselective up to 200mg daily).

NTG –> profound hypotension = think R-sided MI!

For antiplatelets:  prasugrel has fallen out of favor; ticagrelor has better outcomes for certain patient populations than clopidogrel.  FDA recently withdrawal some of the MI indications for clopidogrel (based on data from, ahem, the makers of ticagrelor…).

For anticoagulation:  enoxaparin is preferred over UFH (which is associated with higher CV events) – but we often use UFH because it can be stopped quickly.  Duration 48 hours or until hospital discharge.

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