Which of the following is NOT typically included in long-term pharmacologic therapy for unstable angina?

• A. Aspirin and nitrates
• B. Beta-blockers and statins
• C. Calcium channel blockers
• D. Warfarin (long-term anticoagulation)

Answer: (D)

Long-term management of unstable angina focuses on preventing recurrent ischemia with antiplatelet therapy, relieving ischemia, and addressing risk factors. Aspirin is foundational, as are nitrates for symptom relief. Beta-blockers reduce myocardial oxygen demand and improve outcomes, while statins stabilize plaques and lower ASCVD risk. Calcium channel blockers can be used for ongoing symptoms when beta-blockers aren’t suitable or for vasospastic angina.

Warfarin as a long-term anticoagulant is not routinely included in stable long-term therapy for unstable angina because it increases bleeding risk without clear mortality benefit in this setting. It’s reserved for patients with another indication—such as atrial fibrillation, left ventricular thrombus, or certain valve conditions. Therefore, long-term warfarin is not a standard component of therapy for unstable angina.