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Optimising pharmacotherapy for secondary prevention of non-invasively managed acute coronary syndrome

Despite a trend towards greater use of coronary revascularisation, half of all patients who experienced an acute coronary syndrome (ACS) in Australia in 2012 had their conditions managed non-invasively — that is, they did not receive coronary angiography with subsequent coronary stenting or bypass surgery.1 The evidence base and international guidelines for the management of patients with ACS are extensive,24 but some research suggests that patients whose ACS is treated conservatively may not receive the same level of evidence-based care as those whose ACS is managed invasively.5

This article reviews the optimal pharmacological management of non-invasively managed ACS, and briefly reviews the evidence to support the prescription of each class of drug.

Antithrombotic therapy

As coronary thrombosis is the major cause of ACS, antithrombotic treatment regimens are now routine.


Aspirin in a dose of 75–325 mg daily is recommended in all guidelines for all patients after an ACS, regardless of whether revascularisation has occurred.24 Its low cost and high effectiveness make it an attractive agent to reduce the risk of recurrence of…