Patient handout

Intermediate-risk NSTE-ACS (cath 25-72 h)

PRODUCTION

1. Your condition

This handout is for intermediate-risk nste-acs (cath 25-72 h). Your care team identified this based on: grace 109-140 in nste-acs context — intermediate stratum, cath 25-72 h per acc/aha 2025 iia.

Other reasons your team may use this plan: rising hstn without dynamic ecg changes — intermediate-risk feature; diabetes or ckd presenting with nste-acs lacking high-risk features; recent pci/cabg presenting with nste-acs pattern but no recurrent angina.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg load → 81 mg	PO chewed	load once → 81 mg daily lifelong	Universal — ACC/AHA 2025 Class I
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo standard	PLATO PMID 19717846 + ISAR-REACT 5 PMID 31475799 — preferred over clopidogrel
clopidogrel	600 mg load → 75 mg	PO	daily × 12 mo	Alternative for HBR, on chronic OAC, or ticagrelor intolerant; ACC/AHA 2025 Class IIa
enoxaparin	1 mg/kg SC q12h (1 mg/kg q24h if CrCl 15-30)	SC	q12h until ~24 h pre-cath then UFH	ESSENCE PMID 11519503 — preferred for non-imminent cath in intermediate stratum; switch to UFH at PCI per ACC/AHA 2025
unfractionated_heparin	60 U/kg bolus (max 4000) → 12 U/kg/h infusion	IV	continuous, aPTT 1.5-2× control	Reversible, renal-friendly; preferred at PCI or in advanced CKD
atorvastatin	80 mg	PO	once daily	PROVE-IT PMID 15007110 — start day 0 high-intensity per ACC/AHA 2025 Class I

Plan: Intermediate-risk NSTE-ACS standard antithrombotic load (ASA + P2Y12 + LMWH preferred) — ACC/AHA 2025 + ESC 2023; 25-72 h cath

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent chest pain → ED
BARC 2+ bleed → reassess DAPT
NYHA worsening to III+ → cardiology re-eval

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

New dynamic ECG OR refractory angina OR hemodynamic/electrical instability appears during intermediate-risk admission
New SBP <90 + hypoperfusion OR sustained VT/VF during intermediate-risk admission(life-threatening)
Major bleeding (BARC 3+) on standard DAPT + AC during intermediate-risk admission

5. Follow-up

Cardiac rehab Class I, full 5-pillar the four foundational heart-failure medications, lipid recheck 4-8 wks, DAPT 12 mo standard or de-escalation per TWILIGHT/MASTER DAPT if HBR

6. Sources

Guideline: 2025 ACC/AHA Guideline for ACS (Rao); ESC 2023 NSTE-ACS Guideline (Byrne, PMID 37622670)