anticoagulants in ACS; unstable angina/nstemi

1. direct thrombin inhibitor

1.1. bivalirudin

1.1.1. alternative to unfractioned heparin

1.1.2. added to therapy in pts going for invasive cardiac interventions w/ history of HIT

2. unfractionated heparin

2.1. preferred if patient considered for invsive approach

2.2. monitor: aPTT: target 1.5-2.5x normal control; HGB/HCT; bleeding

3. low molecular weight heparins

3.1. enoxaparin

3.1.1. also first line tx

3.1.2. more difficult to reverse with protamine than UFH; difficulty monitoring degree of anticoag