Diagnostic and Therapeutic Approach to Patients Presenting with Acute Coronary Syndrome (ACS) Focusing on Antiplatelet and Antithrombotic Therapy

*Bivalirudin is an appropriate alternative to UFH and LMWH, or at time of PCI, patients on UFH may be switched to bivalirudin. †Choose either clopidogrel, ticagrelor, or prasugrel as the second antiplatelet agent. ^#Indicators of recurrent ischemia include worsening chest pain, increasing cardiac biomarkers, heart failure signs/symptoms, arrhythmia (VT/VF), and dynamic ECG changes. ¹UFH for 48 hours or LMWH until discharge or up to 8 days and clopidogrel or ticagrelor for 1 year. ASA, aspirin; CABG, coronary artery bypass grafting; CAD, coronary artery disease; EF, ejection fraction; LMWH, low–molecular-weight heparin; NSTEMI, non–ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; Rx, treatment; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina; UFH, unfractionated heparin; VT/VF, ventricular tachycardia/ventricular fibrillation; WMA, wall motion abnormality.^31,37