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HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

188 - The Clot Thickens: Key Updates from the 2025 Acute Coronary Syndromes Guidelines

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5644 Ratings

🗓️ 14 March 2025

⏱️ 36 minutes

🧾️ Download transcript

Summary

In this episode, we review the new 2025 ACC/AHA Acute Coronary Syndrome (ACS) guidelines, with a particular focus on guideline recommendations for analgesics, P2Y12 inhibitors, parenteral anticoagulation, and lipid management.

Key Concepts

  1. Nitrates and opioids are recommended for symptomatic relief of chest pain. Some patients may not be appropriate for nitrates (e.g. recent PDE-5 inhibitor use, hypotension, or right ventricular infarction). Opioids are used for nitrate-refractory angina but have a theoretical risk of delaying the effect of oral antiplatelet medications.
  2. Prasugrel and ticagrelor are preferred P2Y12 inhibitors over clopidogrel in most patients. Patient-specific factors, including the use of PCI, play a role in P2Y12 inhibitor selection.
  3. Anticoagulation with heparin is recommended in nearly all acute coronary syndrome (ACS) scenarios. Alternative anticoagulants may be used depending on whether PCI/CABG is planned and whether the anticoagulant is used prior to PCI/CABG (“upstream”) or during the PCI procedure itself.
  4. LDL goals after ACS have changed again. All ACS patients should have an LDL goal < 70 with a consideration of an LDL goal of 55-69. A variety of non-statin therapies may be added to a high intensity statin regimen if LDL is not at goal.

References

  • Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online February 27, 2025. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309

Transcript

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0:00.0

Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.

0:11.0

This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.

0:17.0

This podcast contains general information for educational purposes only. This is not professional

0:22.4

advice and should not be used in lieu of obtaining advice from a qualified health care provider.

0:27.2

And now on to the show. Welcome to Helix Talk, episode 188. I'm your co-host, Dr. Kane.

0:35.3

And I'm Dr. Patel. And the title of today's episode is

0:38.1

The Clot Thickens, Key Updates from the 2025 Acute Coronary Syndrome's Guidelines. So Dr. Patel,

0:44.5

today we're talking about guidelines that are fresh off the press that it's been a minute since

0:48.4

these have been updated. So kind of exciting to talk about what's new in ACS. Yeah, I believe the

0:53.2

last update was in 2013. And so it's what, 12 years since then?

0:59.0

We haven't seen much of the update, so I'm excited to talk about it.

1:03.0

It's freshly published.

1:05.0

What's kind of important here is that this is a consolidated update of a couple different guidelines that have come out over the years. So our STEMemmy, N-Stemmy, PCI for Stemmy, and then dual anti-platelet therapy guidelines,

1:16.7

which, you know, were released in different years and things like that.

1:19.9

This is designed to kind of consolidate all of those plus have new updates as well.

1:24.7

And usually guidelines can be pretty long read.

1:27.4

These are comparatively just 92 pages.

1:31.2

And I like, you know, that we handbook kind of like the most important pharmacotherapy related aspect,

1:36.4

but it has comprehensive management of ACS guidelines and approach. And of course, like we in our show notes

1:42.9

for again, episode 188 at

1:45.0

Helix Talk.com, we have references to the 92 page guideline. So why don't we start with one big

1:51.1

important section, which is the use of analgesics for chest pain. So when patients have an acute

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