This handout is for octogenarian nste-acs — conservative strategy. Your care team identified this based on: age ≥80 + nste-acs confirmed by 0/1-h hstn algorithm — shared-decision invasive vs conservative per acc/aha 2025.
Other reasons your team may use this plan: clinical frailty scale (rockwood) ≥5 — mild-moderate frailty drives risk-benefit toward conservative; meets arc-hbr major or 2 minor criteria → high bleed risk drives conservative + short dapt (master dapt); egfr <30 + age ≥80 + nste-acs — contrast nephropathy risk weighs against early cath.
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 unless major bleed | Universal — ACC/AHA 2025 Class I; ISIS-2 mortality benefit; lifelong unless ARC-HBR major bleed event |
| clopidogrel | 300 mg load (consider 600 if PCI possible) → 75 mg daily | PO | daily × 3-12 mo per PRECISE-DAPT + MASTER DAPT | Preferred P2Y12 in age ≥80 with frailty/HBR — better bleed profile than ticagrelor or prasugrel; ACC/AHA 2025 Class IIa for elderly HBR |
| ticagrelor | 180 mg load → 90 mg BID (consider 60 mg BID after 12 mo if continued per PEGASUS) | PO | BID × 12 mo if invasive elected and bleed risk acceptable | PLATO PMID 19717846 — net benefit preserved in elderly subgroup; reserve for non-HBR octogenarian who proceeded to PCI |
| fondaparinux | 2.5 mg SC daily | SC | daily until end of hospitalisation or 8 d | OASIS-5 (Yusuf NEJM 2006 PMID 16554528) — fondaparinux 50% lower bleed vs enoxaparin in NSTE-ACS; preferred parenteral AC in elderly conservative path; ACC/AHA 2025 Class I |
| enoxaparin | 1 mg/kg SC q12h (1 mg/kg q24h if CrCl 15-30) | SC | q12h or q24h per CrCl until cath or end of hospitalisation | ESSENCE PMID 11519503; renal dose-adjust mandatory in elderly; switch to UFH at PCI per ACC/AHA 2025 |
| atorvastatin | 80 mg (consider 40 mg if frailty CFS ≥6 or life-expectancy <2 y) | PO | daily | PROVE-IT PMID 15007110 — start day 0; consider moderate-intensity in CFS ≥6 per shared decision (geriatric tolerability) |
Plan: Octogenarian NSTE-ACS conservative-strategy phenotype — gentler antiplatelet + bleed-mitigated AC + AKI-aware contrast plan; adds to parent cardio.nstemi.core.v1
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiac rehab (geriatric-tailored) Class I; lipid recheck 4-8 wks; PRECISE-DAPT-driven DAPT duration (3-6 mo if HBR per MASTER DAPT) with explicit reassessment cadence; geriatrics co-management if frail
Guideline: 2025 ACC/AHA Guideline for ACS (Rao) — elderly + frail section; ESC 2023 NSTE-ACS Guideline (Byrne, PMID 37622670)