Bare Metal Stent

Drug-eluting stent

Predictable chest pain

Usually occurs on exertion/ emotional stress

Lasts < 5 minutes

Relieved by rest, Glyceryl trinitrate (GTN) or both

Irregular rhythm of heartbeat

Too fast

Too slow

Unexpected/ unpredictable chest pain

Occurrences are severe, prolonged and possibly at rest

Lasts long <15~20 minutes

Seek immediate medical attention

Uncomfortable pressure, squeezing, fullness, pain

may radiate to shoulders, arms, back, neck, jaw

Step 1:

Upon the first sign of a heart attack(chest pain, Do not wait until severe pain develops), use one tablet / 1-2 sprays under your tongue. Sit and rest. The medication usually gives relief in less than 5 minutes.

Step 2:

If symptoms persist, continue to sit and rest. Use one tablet / 1-2 sprays under your tongue. Rest for an additional 5 minutes.

Step 3:

If the pain is not relieved after 3 doses, call 995 for an ambulance. You may continue to take 1 tablet / use the spray every 5 minutes to relieve the attack while waiting for the ambulance.

Pharm class: Antiplatelets

MOA: Decrease platelet aggregation and reduce thrombus formation in the coronary arteries

Contraindications:

Hypersensitivity to NSAIDs; patients with asthma, rhinitis, and nasal polyps; use in children or teenagers for viral infections, with or without fever.

Dose:

100mg OM

Common side effects:

Generally mild and infrequent but high incidence of GI irritation with slight asymptomatic blood loss, increased bleeding time, bronchospasm and skin reactions in hypersensitive patients.

Counselling points:

• Take this medication after food as it may cause gastric irritation/discomfort.

• Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

Pharm class: Antiplatelets- P2Y12 platelet inhibitors

MOA: Decrease platelet aggregation and reduce thrombus formation in the coronary arteries

Contraindications:

Active bleeding, Significant liver impairment or cholestatic jaundice.

Dose:

75mg OM

Common side effects:

Abdominal pain, bleeding disorders (including gastro-intestinal and intracranial, diarrhoea, dyspepsia

Counselling points:

• You may take this medication before or after food. If stomach discomfort occurs, please take it after food.

• Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

Pharm class: Antiplatelets - P2Y12 platelet inhibitors

MOA: Same as clopidogrel

Contraindications:

Active bleeding, history of intracranial haemorrhage

Dose:

90mg BD

Common side effects:

Bruising, dyspnoea, haemorrhage

Counselling points:

• You may take this medication before or after food. If stomach discomfort occurs, please take it after food.

• Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

Some patients may be prescribed with 2 antiplatelets after they had a recent heart attack OR just had a surgical intervention done (PCI or CABG) to prevent thrombus formation.

• Aspirin + Clopidogrel/Ticagrelor

• This is NOT therapeutic duplication.

The duration of using two antiplatelets depends on balance between the risk of thrombus formation and bleeding. After completing DAPT,  single antiplatelet therapy should be continued. In most situations, DAPT is indicated for 12 months, and some patients may need to extend the duration of DAPT. Specifically, for percutaneous coronary intervention (PCI) using Drug-Eluting Stents (DES), if patients with low to moderate bleeding/ischemic risk, DAPT is recommended for 6 months.