''NSTEMI''
Give //Aspirin// 300mg and continue at 75-150mg daily for life
Give //nitrates// or morphine for pain as required
//Oxygen// if hypoxic
//Clopidogrel//  - unless CI - bleeding risk (300mg and continue at 75mg daily for 12/12 - for life if aspirin sensitive)
//Antithrombin// (Fondaparinux) if not high risk for bleeding and not angiography in next 24hrs, if angio or creatinine >265 - give unfractionated heparin
IV //Glycoprotein 2b/3a antagonists// (eptifibatide/tirofiban) if higher risk of CVS events (GRACE 6/12 over 3.0%) or angio within 96hrs
//Angiography// - consider within 96hrs for GRACE 6/12 >3.0% or clinically unstable

If low risk - stop Clopidogel 5/7 pre CABG - if high risk of ischaemia - discuss with surgeon (balance bleeding and ischaemia risk)
SE Clopidogrel - bruising, GI bleed, haematoma, dyspepsia

''Unstable Angina''
if 6/12mort<3% then Mx conservatively
if 6/12mort>3% then offer angiography (+PCI if indicated)
within 6/52 if stable
within 96 hours if unstable (as soon as possible)

Disharge with .... Aspirin, Clopidogrel, Statin, antiHT, anti-anginal - beware Clopidogrel and Omeprazole

''Action Mechanisms''
Aspirin - antiplatelet - inhibits thromboxane A2
Clopidogrel - antiplatlet - inhibits ADP binding
Enoxaparin and Fondaparinux - activates antithrombin3 so potentiating inhibition of coag Xa
Bivalirudin - reversible direct thrombin inhibitor