One of the tenets of treatment of ACS (unstable angina, NSTEMI, STEMI) is treatment with an anticoagulant like heparin or enoxaparin. The “heparin vs. enoxaparin” issue is a totally different discussion. What this post addresses is a gray area: does every patient with unstable angina need to be started on a heparin drip?
Heparin is a medication that has potential side effects (bleeding, immune reaction) and takes time and resources (maintaining a patient on a drip, PTT draws).
I think that if a patient has had chest pain within the past 24 hours, then it would be prudent to start a heparin drip, as unstable angina can escalate into an NSTEMI on short notice. There are several high-risk features that should prompt a heparin drip (reference):
- history of MI
- EKG changes
- abnormal stress test
- a strong history suggestive of UA
What about aspirin? EVERY patient with suspected unstable angina should get 324 mg of aspirin. There is virtually no harm to giving a single dose of aspirin, so you might as well give it.