Treatment of Unstable Angina

Initial Management

The American Heart Association recommends that patients with unstable angina should be hospitalized, preferably in a coronary care unit, for close monitoring and aggressive treatment 1, 2
The European Society of Cardiology suggests providing short-acting nitroglycerin for immediate symptom relief with appropriate instructions on proper use 3, 4
The American College of Cardiology recommends administering aspirin 75-150 mg daily as it significantly reduces the risk of myocardial infarction, stroke, or death (risk reduction of 5.5% in unstable angina) 5, 6
The American Heart Association recommends starting intravenous beta-selective blockers without intrinsic sympathomimetic activity, with oral beta-blockers substituted later during hospitalization 1
The American College of Cardiology suggests initiating anticoagulation with heparin (unfractionated or low molecular weight) 1, 7

Beta-blockers: The American Heart Association recommends administering beta-blockers initially intravenously in hemodynamically stable patients, followed by oral maintenance therapy 1
Nitrates: The European Society of Cardiology suggests using intravenous nitroglycerin for acute management, followed by long-acting nitrates for maintenance therapy 1, 3
Aspirin: The American College of Cardiology recommends continuing aspirin 75-150 mg daily long-term (at least 18 months) 5, 6
Heparin: The American Heart Association suggests using either unfractionated heparin or low molecular weight heparin 7

The European Society of Cardiology defines high-risk patients as those with recurrent ischemia, elevated troponin levels, hemodynamic instability, major arrhythmias, or early post-infarction unstable angina 2
The American College of Cardiology recommends early coronary angiography (within initial hospitalization) for high-risk patients 2
The European Society of Cardiology suggests that if symptoms persist despite optimal medical therapy, coronary angiography followed by appropriate revascularization (PCI or CABG) is indicated 2

The American College of Cardiology recommends continuing aspirin 75 mg daily long-term 5, 6
The European Society of Cardiology suggests maintaining beta-blocker therapy, particularly in post-MI patients 8
The American Heart Association recommends continuing statin therapy for all patients with coronary disease 8, 9
The European Society of Cardiology suggests considering clopidogrel as an alternative antiplatelet agent in patients who cannot take aspirin 8

The American College of Cardiology warns against immediate-release or short-acting dihydropyridine calcium antagonists as they may increase adverse cardiac events 10
The American Heart Association recommends avoiding nitrate tolerance by ensuring a daily "nitrate-free" interval when using long-acting nitrates 9