Acute coronary syndrome

SIGN 148: Acute coronary syndrome NICE NG185: Acute coronary syndromes

Antiplatelet therapy (non ST and ST elevation)

For 6 months (in most patients) then change to single drug, see prescribing notes on duration of anti-platelet therapy.

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 300mg, then 75mg daily.

Clopidogrel
Clopidogrel 75mg tablets

Initial loading dose of 300mg ,then 75mg once daily.

In acute coronary syndrome, prasugrel may be considered in high risk patients with consideration given to the balance of benefit (prevention of recurrent MI) and harm (major bleeding).

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 300mg, then 75mg daily.

Prasugrel
Prasugrel 10mg tablets

Loading dose 60mg for 1 dose then 10mg once daily, see prescribing notes.

Ticagrelor is considered to be an alternative to prasugrel in patients with a past medical history of stroke or TIA or >75years.

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 300mg, then 75mg daily.

Ticagrelor
Ticagrelor 90mg tablets

Initially 180mg for one dose, then 90mg twice daily.

Ticagrelor 90mg orodispersible tablets sugar free

Initially 180mg for one dose, then 90mg twice daily.

Prescribing Notes:

  • Patients with acute coronary syndrome should receive dual antiplatelet therapy for six months. Longer durations may be used where the risks of atherothrombotic events outweigh the risk of bleeding. Shorter durations may be used where the risks of bleeding outweigh the risk of artherothrombotic events. SIGN 148.
  • The co-prescribing of clopidogrel with omeprazole or esomeprazole should be avoided due to the potential antagonism of the anti-platelet effect.  If concomitant use of clopidogrel and a PPI is necessary, then lansoprazole would be an appropriate choice.
  • Prasugel may be used in patients less than 75 years old, weight greater than 60kg who have a proven intolerance to clopidogrel or who present with stent thrombosis whilst taking clopidogrel. The 5mg dose is not recommended in NHS Scotland.

History Notes

16/02/2022

East Region Formulary content agreed.

Secondary prevention with statin
Atorvastatin
Atorvastatin 10mg tablets

40-80mg to be taken in the morning.

Atorvastatin 20mg tablets

40-80mg to be taken in the morning.

Atorvastatin 40mg tablets

40-80mg to be taken in the morning.

Atorvastatin 80mg tablets

40-80mg to be taken in the morning.

Rosuvastatin
Rosuvastatin 5mg tablets

Initially 5-10mg once daily, then increased up to 20mg once daily at intervals of at least four weeks. See BNF for further details.

Rosuvastatin 10mg tablets

Initially 5-10mg once daily, then increased up to 20mg once daily at intervals of at least four weeks. See BNF for further details.

Rosuvastatin 20mg tablets

Initially 5-10mg once daily, then increased up to 20mg once daily at intervals of at least four weeks. See BNF for further details.

Prescribing Notes:

  • See SIGN guideline 149 and NICE Clinical Guideline 181.
  • Lowering cholesterol is associated with reduced mortality and morbidity in patients at high and moderate risk of, or with established, cardiovascular and cerebrovascular disease.
  • Chewable atorvastatin tablets can be prescribed for those patients with swallowing difficulties.
  • Fibrates have been less well tested in clinical trials. They are mainly of benefit in those with mixed hyperlipidaemia and low HDL cholesterol.
  • Caution should be exercised when prescribing other drugs with statins. Statins interact with many drugs. See BNF for full details of drug interactions.
  • The MHRA has produced recommendations for dose restrictions when used with some other drugs as interactions may increase the risk of adverse effects, or reduce the effectiveness of statin treatment.
  • Ezetimibe may be considered in combination with a statin for patients who have failed to reach target cholesterol levels despite treatment with titrated/optimised statins alone. 

History Notes

07/03/2024

Prescribing information updated, ERFC Feb 2024

16/02/2022

East Region Formulary content agreed.

Secondary prevention - statin intolerance

Statins are more effective than any other lipid lowering option. See prescribing notes.

Ezetimibe may be considered as monotherapy where statins are inappropriate or poorly tolerated

Ezetimibe
Ezetimibe 10mg tablets

10mg daily.

Prescribing Notes:

  • If someone reports adverse effects when taking statins discuss:
    • stopping the statin and trying again when the symptoms have resolved to check if the symptoms are related to the statin;
    • reducing the dose within the same intensity group; or
    • changing the statin to a lower intensity group.
  • There may be a role for ezetimibe in secondary prevention in patients who are statin intolerant (intolerance to ≥3 agents) or those who fail to achieve target LDL on maximum tolerated dose of statin. Consider referral for specialist advice.

History Notes

07/03/2024

Specialist initiation flag removed for ezetimibe, ERFC Feb 2024

16/02/2022

East Region Formulary content agreed.

Thromboprophylaxis post-MI
Fondaparinux sodium
Fondaparinux sodium 2.5mg/0.5ml solution for injection pre-filled syringes

As per specialist. Maximum 8 days.

Prescribing Notes:

  • In STEMI first dose is given intravenously, and subsequent doses are given subcutaneously. Treatment is for a minimum of 2 days, up to a maximum of 8 days; In NSTEMI/Unstable angina, doses are given subcutaneously. Treatment is for a minimum of 2 days and a maximum of 8 days.
  • Benefits and risks of treatment with fondaparinux should be assessed for patients with eGFR between 20 and 30ml/min: Avoid if eGFR less than 20ml/min.
  • For NHS Lothian patients, the Edinburgh renal unit (Edren) website may contain helpful information.

History Notes

16/02/2022

East Region Formulary content agreed.

Antiplatelets for secondary prevention post stent insertion

For 6 months (in most patients) then change to single drug, see prescribing notes on duration of anti-platelet therapy.

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 150mg-300mg, then 75mg daily.

Clopidogrel
Clopidogrel 75mg tablets

Initial loading dose of 300mg ,then 75mg once daily.

In acute coronary syndrome, ticagrelor or prasugrel may be considered in high risk patients with consideration given to the balance of benefit (prevention of recurrent MI) and harm (major bleeding).

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 150mg-300mg, then 75mg daily.

Prasugrel
Prasugrel 10mg tablets

Loading dose 60mg for 1 dose then 10mg once daily, see prescribing notes.

Ticagrelor is considered to be an alternative to prasugrel in patients with a past medical history of stroke or TIA or >75years.

Aspirin
Aspirin 75mg dispersible tablets

Initially loading dose of 300mg, then 75mg daily.

Ticagrelor
Ticagrelor 90mg tablets

Initially 180mg for one dose, then 90mg twice daily.

Ticagrelor 90mg orodispersible tablets sugar free

Initially 180mg for one dose, then 90mg twice daily.

Prescribing Notes:

  • Patients with acute coronary syndrome should receive dual antiplatelet therapy for six months. Longer durations may be used where the risks of atherothrombotic events outweigh the risk of bleeding. Shorter durations may be used where the risks of bleeding outweigh the risk of artherothrombotic events. SIGN 148.
  • The co-prescribing of clopidogrel with omeprazole or esomeprazole should be avoided due to the potential antagonism of the anti-platelet effect.  If concomitant use of clopidogrel and a PPI is necessary, then lansoprazole would be an appropriate choice.
  • Ticagrelor (or prasugrel) are recommended in SIGN 148.
  • Prasugel may be used in patients less than 75 years old, weight greater than 60kg who have a proven intolerance to clopidogrel or who present with stent thrombosis whilst taking clopidogrel. The 5mg dose is not recommended in NHS Scotland.

History Notes

16/02/2022

East Region Formulary content agreed.