Anticoagulation in Acute Coronary Syndrome

Introduction to Anticoagulation

• The European Society of Cardiology recommends anticoagulation for all patients with acute coronary syndrome without ST elevation, in addition to antiplatelet therapy, at the time of diagnosis and especially during revascularization procedures, according to ischemic and hemorrhagic risk 1, 2

Fundamentals of Anticoagulation

• Anticoagulation is obligatory during percutaneous coronary intervention to prevent thrombotic complications 1, 2

Options for Anticoagulation

• Unfractionated heparin is recommended for patients undergoing percutaneous coronary intervention with the following doses:
• Fondaparinux is recommended when there is medical treatment or logistical limitations to transfer the patient to percutaneous coronary intervention within the required time 1, 2

Selection of Anticoagulant

• The anticoagulant should be selected based on the patient's ischemic and hemorrhagic risk 1, 2
• The European Society of Cardiology recommends not switching between unfractionated heparin and low molecular weight heparin 1, 2

Integration with Antiplatelet Strategy

• Anticoagulation should be administered in addition to dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) 1, 2
• Ticagrelor (180 mg loading dose, 90 mg twice daily) is recommended for patients with moderate to high risk of ischemic events 4, 5, 6

Timing of Anticoagulation

• Anticoagulation should be started at the time of diagnosis of acute coronary syndrome without ST elevation 1, 2
• An immediate invasive strategy (<2 hours) is recommended for patients with very high-risk criteria 1, 7, 8
• An early invasive strategy (<24 hours) is recommended for patients with high-risk criteria 1, 7, 8