Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For secondary prevention of myocardial infarction (MI), the key pharmacological treatments you should prescribe include:
- Angiotensin-converting enzyme (ACE) inhibitors: Offer to all people who have had an MI, starting as soon as they are haemodynamically stable, and continue indefinitely with dose titration to the maximum tolerated or target dose NICE NG185.
- Beta-blockers: Offer to all people after an MI, continuing for at least 12 months. For those with reduced left ventricular ejection fraction, continue indefinitely NICE NG185.
- Dual antiplatelet therapy (DAPT): Offer aspirin plus a second antiplatelet agent (e.g., clopidogrel or ticagrelor) for up to 12 months unless contraindicated. Aspirin should be continued indefinitely unless contraindicated NICE NG185.
- Statins: Prescribe statin therapy for all adults with clinical evidence of cardiovascular disease for lipid lowering NICE NG185.
- Angiotensin II receptor blockers (ARBs): Offer as an alternative to ACE inhibitors in people intolerant to ACE inhibitors NICE NG185.
- Aldosterone antagonists: Consider in people with symptoms and/or signs of heart failure and reduced left ventricular ejection fraction post-MI, preferably after ACE inhibitor therapy NICE NG185.
Additional considerations include monitoring renal function, serum potassium, and blood pressure during treatment, and assessing bleeding risk before and during antiplatelet therapy NICE NG185.