What should be done with NSAIDs and COX-2 inhibitors at the time of acute coronary syndrome presentation?

When a patient presents with acute coronary syndrome, the use of NSAIDs and COX-2 inhibitors is typically discontinued due to the associated bleeding risk. This concern arises because these medications can increase the risk of gastrointestinal bleeding and may also affect platelet function, which is critical in the setting of an acute coronary event where clot formation is necessary to address the underlying pathology.

Moreover, the pharmacodynamics of NSAIDs can interfere with antiplatelet therapies that are often initiated in such situations, like aspirin. By discontinuing NSAIDs and COX-2 inhibitors, clinicians minimize the risk of further complications, ensuring that any bleeding tendencies are mitigated during the acute management phase.

Other options, such as continuing the prescribed NSAIDs or COX-2 inhibitors, would not be prudent considering the heightened risk of adverse effects during acute coronary syndrome. Replacing them with acetaminophen does not adequately address the potential hemorrhagic complications and might not provide sufficient analgesia in managing acute pain. Lowering the dose if pain persists does not mitigate the inherent risks involved with these medications in this specific clinical scenario. Thus, the best approach is to discontinue NSAIDs and COX-2 inhibitors.