Medicines for unstable angina

Certain medicines can help keep blood from clotting, reduce the risk that unstable angina may develop into a heart attack, and decrease your chance of dying. These include:

• Aspirin.
• Antiplatelet medicines, such as clopidogrel (Plavix).
• Anticoagulants, such as heparin, enoxaparin (Lovenox), dalteparin (Fragmin), and bivalirudin (Angiomax). Some anticoagulants, such as bivalirudin, are only used in the hospital.

Medicines that decrease the heart's workload, improve blood flow to the heart, and relieve chest pain are usually given to people with unstable angina who are at risk of heart attack. These medicines include:

• Morphine.
• Nitrates, such as nitroglycerin or isosorbide dinitrate (for example, Isordil).
• Beta-blockers, such as carvedilol (Coreg) or metoprolol (for example, Lopressor).

In some cases, additional medicines may be used, including:

• Glycoprotein IIb/IIIa inhibitors, which help prevent clotting. These medicines are only used in the hospital, such as during a heart attack or after an angioplasty.
• Calcium channel blockers, which are used when beta-blockers cannot be taken.
• Angiotensin-converting enzyme (ACE) inhibitors, which are used to control high blood pressure and reduce the heart's workload.
• Insulin, which is used to help control high blood sugar.

Medicines for a heart attack in progress

Medicines for a heart attack work to open the blocked artery to restore blood flow as fast as possible and to decrease the workload on the heart.

• Aspirin and other antiplatelet medicines, anticoagulants (such as heparin), glycoprotein IIb/IIIa inhibitors (if angioplasty is needed), and especially "clot-busting" thrombolytics all work to open clogged arteries. Thrombolytics virtually break up clots by dissolving them, and the other medicines prevent clots from enlarging.
• Oxygen therapy, nitrates (such as nitroglycerin), and beta-blockers work to decrease the workload on the heart, thereby decreasing the amount of oxygen needed and possibly saving heart muscle.

Medicines after a heart attack

After a heart attack, your doctor may give you medicines to prevent heart failure and prevent or reduce the risk of irregular heartbeats (arrhythmias), both of which can happen after a heart attack. These medicines include:

• ACE inhibitors, which lower blood pressure and lower the heart's workload.
• Beta-blockers, which improve blood flow to the heart and lower the heart's workload.

Your doctor may also give you medicines to prevent blood clots from forming and causing a stroke or another heart attack. These medicines include:

• Aspirin.
• Antiplatelet medicines.
• Anticoagulants. If you take the anticoagulant warfarin (Coumadin), see:

  Eating a steady amount of vitamin K when you take warfarin (Coumadin).

If you have high cholesterol, your doctor may prescribe cholesterol-lowering medicines called statins to prevent future heart attacks.

Nitrates may be used to control remaining angina symptoms.

What to Think About

Do not substitute nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, for example) or naproxen (such as Aleve), for aspirin. Although NSAIDS relieve pain and inflammation much like aspirin does, they may increase your risk for a heart attack or stroke.

If you had angioplasty and got a stent, you will take antiplatelet medicines to help prevent another heart attack or a stroke. You will probably take aspirin plus another antiplatelet such as clopidogrel (Plavix). If you get a drug-eluting stent, you will probably take both of these medicines for at least one year. If you get a bare metal stent, you will take both medicines for at least one month but maybe up to one year. Then, you will likely take daily aspirin long-term. If you have a high risk of bleeding, your doctor may shorten the time you take these medicines.