Choice of initial anticoagulation agent in patients with non-ST-elevation acute coronary syndrome

All patients with NSTEACS should undergo anticoagulation unless contraindications to anticoagulation are present. The choice of initial agent is not influenced by the choice of antiplatelet therapy (eg, clopidogrel, ticagrelor). Dosing for each agent is discussed within UpToDate and UpToDate Lexidrug.

NSTEACS: non-ST-elevation acute coronary syndrome; NSTEMI: non-ST-elevation myocardial infarction; PCI: percutaneous coronary intervention; UFH: unfractionated heparin.

* The specific choice of agent depends on ease of dosing, familiarity, and cost. If enoxparin or fondaparinux were used as initial anticoagulation and invasive coronary angiography will be performed, refer to UpToDate topics on anticoagulation in NSTEACS for information on converting agents and dosing.

¶ An "invasive" strategy refers to invasive coronary angiography soon after diagnosis without prior noninvasive imaging (eg, nulcear stress perfusion) and is typically appropriate for patients with elevated troponin, ST-segment depression, or high-risk clinical features (eg, recent PCI). A "noninvasive" strategy refers to invasive coronary angiography only after results of noninvasive imaging suggest the presence of significant coronary artery disease. For information on choosing a strategy, refer to UpToDate topics on the choice of management strategy in patients with NSTEACS (ie, NSTEMI or unstable angina).

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Choice of initial anticoagulation agent in patients with non-ST-elevation acute coronary syndrome