Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for warfarin therapy
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Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for warfarin therapy On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
When warfarin is used in conjunction with antiplatelet agents, there is an increased risk of bleeding. The treating physician should be aware of this to provide the appropriate monitoring and management.
2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update) (DO NOT EDIT)[1][2]
Warfarin Therapy (DO NOT EDIT)[1][2]
| Class I |
| "1. Use of warfarin in conjunction with aspirin and/or P2Y12 receptor inhibitor therapy is associated with an increased risk of bleeding, and patients and clinicians should watch for bleeding, especially GI, and seek medical evaluation for evidence of bleeding.[3][4][5][6][7][8][9][10] (Level of Evidence: A)" |
| Class IIb |
| "1. Warfarin either without (INR 2.5 to 3.5) or with low-dose aspirin (81 mg per day; INR 2.0 to 2.5) may be reasonable for patients at high coronary artery disease risk and low bleeding risk who do not require or are intolerant of P2Y12 receptor inhibitor therapy.[11][12] (Level of Evidence: B)" |
| "2. Targeting oral anticoagulant therapy to a lower INR (eg, 2.0 to 2.5) might be reasonable in patients with UA/NSTEMI managed with aspirin and a P2Y12 inhibitor. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 2012 Writing Committee Members. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR; et al. (2012). "2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 126 (7): 875–910. doi:10.1161/CIR.0b013e318256f1e0. PMID 22800849.
- ↑ 2.0 2.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". Journal of the American College of Cardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-12. Unknown parameter
|month=ignored (help) - ↑ Sosnowski C (2008). "[Commentary to the article: Wiviott S D, Braunwald E, McCabe C H et al. Prasugrel versus clopidogrel in patients with acute coronary syndrome. N Engl J Med 2007; 357: 2001-15]". Kardiol Pol. 66 (2): 222–5, discussion 225-6. PMID 18634190.
- ↑ Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C; et al. (2009). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4
- ↑ Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK; et al. (2001). "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation". N Engl J Med. 345 (7): 494–502. doi:10.1056/NEJMoa010746. PMID 11519503. Review in: ACP J Club. 2002 Mar-Apr;136(2):45
- ↑ Brouwer MA, van den Bergh PJ, Aengevaeren WR, Veen G, Luijten HE, Hertzberger DP; et al. (2002). "Aspirin plus coumarin versus aspirin alone in the prevention of reocclusion after fibrinolysis for acute myocardial infarction: results of the Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis (APRICOT)-2 Trial". Circulation. 106 (6): 659–65. PMID 12163424.
- ↑ Fiore LD, Ezekowitz MD, Brophy MT, Lu D, Sacco J, Peduzzi P; et al. (2002). "Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study". Circulation. 105 (5): 557–63. PMID 11827919. Review in: J Fam Pract. 2002 Jun;51(6):518 Review in: ACP J Club. 2002 Sep-Oct;137(2):47
- ↑ Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H (2002). "Warfarin, aspirin, or both after myocardial infarction". N Engl J Med. 347 (13): 969–74. doi:10.1056/NEJMoa020496. PMID 12324552. Review in: ACP J Club. 2003 Mar-Apr;138(2):34 Review in: J Fam Pract. 2003 Jan;52(1):28-31
- ↑ van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE, Antithrombotics in the Secondary Preventionof Events in Coronary Thrombosis-2 (ASPECT-2) Research Group (2002). "Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial". Lancet. 360 (9327): 109–13. doi:10.1016/S0140-6736(02)09409-6. PMID 12126819. Review in: ACP J Club. 2003 Jan-Feb;138(1):9
- ↑ "Early Communication about an Ongoing Safety Review of clopidogrel bisulfate (marketed as Plavix)".
- ↑ Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL; et al. (2001). "A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke". N Engl J Med. 345 (20): 1444–51. doi:10.1056/NEJMoa011258. PMID 11794192.
- ↑ Peverill RE, Harper RW, Smolich JJ (1997). "CARS trial: warfarin and thrombin generation. Coumadin Aspirin Reinfarction Study". Lancet. 350 (9085): 1177–8. PMID 9343528.