Unstable angina non ST elevation myocardial infarction additional management considerations for antiplatelet and anticoagulant therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The guidelines below outline the continued recommendations for patients with unstable angina or NSTEMI in regards to stress testing, anticoagulant therapy and antiplatelet therapy. Different guidelines are given on pharmacotherapy depending on the specific situation, such as in the setting of CABG.

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]

Additional Management of Antiplatelets and Anticoagulants (DO NOT EDIT)[1]

Class I
"1. For UA/NSTEMI patients in whom an initial conservative strategy is selected and no subsequent features appear that would necessitate diagnostic angiography (recurrent symptoms/ischemia, heart failure, or serious arrhythmias), a stress test should be performed.[2] (Level of Evidence: B)

a) If, after stress testing, the patient is classified as not at low risk, diagnostic angiography should be performed.[3][2] (Level of Evidence: A)

b) If, after stress testing, the patient is classified as being at low risk, the instructions noted below should be followed in preparation for discharge[3][2]:

"2. For UA/NSTEMI patients in whom CABG is selected as a postangiography management strategy, the instructions noted below should be followed.

a) Continue ASA.[18][19][20][21][22][23][24] (Level of Evidence: A)

b) See Class I, #3, in this section.

c) Discontinue intravenous GP IIb/IIIa inhibitor (eptifibatide or tirofiban) 4 h before CABG.[18][22][25] (Level of Evidence: B)

d) Anticoagulant therapy should be managed as follows:

"3. In patients taking a P2Y12 receptor inhibitor in whom CABG is planned and can be delayed, it is recommended that the drug be discontinued to allow for dissipation of the antiplatelet effect[9] (Level of Evidence: B). The period of withdrawal should be at least 5 days in patients receiving clopidogrel[9][33] (Level of Evidence: B) or ticagrelor* (Level of Evidence: C) and at least 7 days in patients receiving prasugrel** (Level of Evidence: C) unless the need for revascularization and/or the net benefit of the P2Y12 receptor inhibitor therapy outweighs the potential risks of excess bleeding.[34] (Level of Evidence: C) "
"4. For UA/NSTEMI patients in whom PCI has been selected as a postangiography management strategy, the instructions noted below should be followed:

a) Continue aspirin.[4][5][6] (Level of Evidence: A)

b) Administer a loading dose of a P2Y12 receptor inhibitor if not started before diagnostic angiography.[7][35][36][37][38][39] (Level of Evidence: A)

c) Discontinue anticoagulant therapy after PCI for uncomplicated cases.[14][16][40][41][42] (Level of Evidence: B)"

"5. For UA/NSTEMI patients in whom medical therapy is selected as a management strategy and in whom no significant obstructive CAD on angiography was found, antiplatelet and anticoagulant therapy should be administered at the discretion of the clinician (Level of Evidence: C). For patients in whom evidence of coronary atherosclerosis is present (e.g., luminal irregularities or intravascular ultrasound demonstrated lesions), albeit without flow-limiting stenoses, long-term treatment with ASA and other secondary prevention measures should be prescribed. (Level of Evidence: C)"
"6. For UA/NSTEMI patients in whom medical therapy is selected as a management strategy and in whom coronary artery disease was found on angiography, the following approach is recommended:

a) Continue aspirin.[4][5][6] (Level of Evidence: A)

b) Administer a loading dose of clopidogrel or ticagrelor* if not given before diagnostic angiography.[7][9] (Level of Evidence: B)

c) Discontinue IV GP IIb/IIIa inhibitor if started previously.[10][11][43][44] (Level of Evidence: B)

d) Anticoagulant therapy should be managed as follows:

"7. For UA/NSTEMI patients in whom a conservative strategy is selected and who do not undergo angiography or stress testing, the instructions noted below should be followed:

a) Continue aspirin indefinitely.[4][5][6] (Level of Evidence: A)

b) Continue clopidogrel or ticagrelor* for up to 12 months.[7][9][48][49] (Level of Evidence: B)

c) Discontinue IV GP IIb/IIIa inhibitor if started previously.[10][11] (Level of Evidence: A)

d) Continue UFH for 48 hours[12][13] (Level of Evidence: A) or administer enoxaparin[14][15][16] (Level of Evidence: A) or fondaparinux[17] (Level of Evidence: B) for the duration of hospitalization, up to 8 days, and then discontinue anticoagulant therapy."

"8. For UA/NSTEMI patients in whom an initial conservative strategy is selected and in whom no subsequent features appear that would necessitate diagnostic angiography (recurrent symptoms / ischemia, HF, or serious arrhythmias), Left Ventricular Ejection Fraction should be measured.[3][50][51][52][53] (Level of Evidence: B)"
Class III (No Benefit)
"1. Intravenous fibrinolytic therapy is not indicated in patients without acute ST segment elevation, a true posterior MI, or a presumed new left bundle branch block (LBBB).[54] (Level of Evidence: A)"
Class IIa
"1. For UA/NSTEMI patients in whom PCI has been selected as a postangiography management strategy, it is reasonable to administer an IV GP IIb/IIIa inhibitor (abciximab, eptifibatide, or tirofiban) if not started before diagnostic angiography, particularly for troponin-positive and/or other high-risk patients.[3][55] (Level of Evidence: A)"
"2. For UA/NSTEMI patients in whom PCI is selected as a post angiography management strategy, it is reasonable to omit administration of an intravenous GP IIb/IIIa antagonist if bivalirudin was selected as the anticoagulant and at least 300 mg of clopidogrel was administered at least 6 h earlier.[3][43] (Level of Evidence: B)"
"3. If Left Ventricular Ejection Fraction is ≤40%, it is reasonable to perform diagnostic angiography.[50][51][52][53] (Level of Evidence: B)"
"4. If Left Ventricular Ejection Fraction is >40%, it is reasonable to perform a stress test.[50] (Level of Evidence: B)"
Class IIb
"1. Platelet function testing to determine platelet inhibitory response in patients with UA/NSTEMI (or, after ACS and PCI) on P2Y12 receptor inhibitor therapy may be considered if results of testing may alter management.[56][57][58][59][60] (Level of Evidence: B)"
"2. Genotyping for a CYP2C19 loss of function variant in patients with UA/NSTEMI (or, after ACS and with PCI) on P2Y12 receptor inhibitor therapy might be considered if results of testing may alter management.[61][62][63][64][65][66][67] (Level of Evidence: C)"
“

* The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily. The benefits of ticagrelor were observed irrespective of prior therapy with clopidogrel. When possible, discontinue ticagrelor at least 5 d before any surgery. Issues of patient compliance may be especially important. Consideration should be given to the potential and as yet undetermined risk of intracranial hemorrhage in patients with prior stroke or TIA.

** Patients weighing <60 kg have an increased exposure to the active metabolite of prasugrel and an increased risk of bleeding on a 10-mg once-daily maintenance dose. Consideration should be given to lowering the maintenance dose to 5 mg in patients who weigh <60 kg, although the effectiveness and safety of the 5-mg dose have not been studied prospectively. For post-PCI patients, a daily maintenance dose should be given for at least 12 mo for patients receiving DES and up to 12 months for patients receiving BMS unless the risk of bleeding outweighs the anticipated net benefit afforded by a P2Y12 receptor inhibitor. Do not use prasugrel in patients with active pathological bleeding or a history of TIA or stroke. In patients age ≥75 y, prasugrel is generally not recommended because of the increased risk of fatal and intracranial bleeding and uncertain benefit except in high-risk situations (patients with diabetes or a history of prior MI), in which its effect appears to be greater and its use may be considered. Do not start prasugrel in patients likely to undergo urgent CABG. When possible, discontinue prasugrel at least 7 d before any surgery. Additional risk factors for bleeding include body weight <60 kg, propensity to bleed, and concomitant use of medications that increase the risk of bleeding (eg, warfarin, heparin, fibrinolytic therapy, or chronic use of nonsteroidal anti-inflammatory drugs).

”

References

  1. ↑ 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. ↑ 2.0 2.1 2.2 "Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators". Lancet. 354 (9180): 708–15. 1999. PMID 10475181.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N; et al. (2001). "Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban". N Engl J Med. 344 (25): 1879–87. doi:10.1056/NEJM200106213442501. PMID 11419424. Review in: ACP J Club. 2002 Jan-Feb;136(1):4
  4. ↑ 4.0 4.1 4.2 4.3 Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA; et al. (1985). "Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial". N Engl J Med. 313 (22): 1369–75. doi:10.1056/NEJM198511283132201. PMID 3903504.
  5. ↑ 5.0 5.1 5.2 5.3 Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE; et al. (1983). "Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study". N Engl J Med. 309 (7): 396–403. doi:10.1056/NEJM198308183090703. PMID 6135989.
  6. ↑ 6.0 6.1 6.2 6.3 Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH (1997). "Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men". N Engl J Med. 336 (14): 973–9. doi:10.1056/NEJM199704033361401. PMID 9077376.
  7. ↑ 7.0 7.1 7.2 7.3 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
  8. ↑ James SK, Roe MT, Cannon CP, Cornel JH, Horrow J, Husted S; et al. (2011). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial". BMJ. 342: d3527. doi:10.1136/bmj.d3527. PMC 3117310. PMID 21685437.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 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
  10. ↑ 10.0 10.1 10.2 "Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators". N Engl J Med. 338 (21): 1488–97. 1998. doi:10.1056/NEJM199805213382102. PMID 9599103.
  11. ↑ 11.0 11.1 11.2 "Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy". N Engl J Med. 339 (7): 436–43. 1998. doi:10.1056/NEJM199808133390704. PMID 9705684.
  12. ↑ 12.0 12.1 12.2 Théroux P, Ouimet H, McCans J, Latour JG, Joly P, Lévy G; et al. (1988). "Aspirin, heparin, or both to treat acute unstable angina". N Engl J Med. 319 (17): 1105–11. doi:10.1056/NEJM198810273191701. PMID 3050522.
  13. ↑ 13.0 13.1 13.2 Yusuf S, Wittes J, Friedman L (1988). "Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction". JAMA. 260 (14): 2088–93. PMID 2901501.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 Cohen M, Demers C, Gurfinkel EP, Turpie AG, Fromell GJ, Goodman S; et al. (1997). "A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group". N Engl J Med. 337 (7): 447–52. doi:10.1056/NEJM199708143370702. PMID 9250846.
  15. ↑ 15.0 15.1 15.2 Antman EM, Cohen M, Radley D, McCabe C, Rush J, Premmereur J; et al. (1999). "Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction. TIMI 11B-ESSENCE meta-analysis". Circulation. 100 (15): 1602–8. PMID 10517730.
  16. ↑ 16.0 16.1 16.2 16.3 Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D; et al. (1999). "Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial". Circulation. 100 (15): 1593–601. PMID 10517729.
  17. ↑ 17.0 17.1 17.2 Mehta SR, Granger CB, Eikelboom JW, Bassand JP, Wallentin L, Faxon DP; et al. (2007). "Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: results from the OASIS-5 trial". J Am Coll Cardiol. 50 (18): 1742–51. doi:10.1016/j.jacc.2007.07.042. PMID 17964037.
  18. ↑ 18.0 18.1 Bizzarri F, Scolletta S, Tucci E, Lucidi M, Davoli G, Toscano T; et al. (2001). "Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting". J Thorac Cardiovasc Surg. 122 (6): 1181–5. doi:10.1067/mtc.2001.117838. PMID 11726894.
  19. ↑ Bybee KA, Powell BD, Valeti U, Rosales AG, Kopecky SL, Mullany C; et al. (2005). "Preoperative aspirin therapy is associated with improved postoperative outcomes in patients undergoing coronary artery bypass grafting". Circulation. 112 (9 Suppl): I286–92. doi:10.1161/CIRCULATIONAHA.104.522805. PMID 16159833.
  20. ↑ Dacey LJ, Munoz JJ, Johnson ER, Leavitt BJ, Maloney CT, Morton JR; et al. (2000). "Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients". Ann Thorac Surg. 70 (6): 1986–90. PMID 11156107.
  21. ↑ Goldman S, Copeland J, Moritz T, Henderson W, Zadina K, Ovitt T; et al. (1988). "Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration Cooperative Study". Circulation. 77 (6): 1324–32. PMID 3286040.
  22. ↑ 22.0 22.1 Lincoff AM, LeNarz LA, Despotis GJ, Smith PK, Booth JE, Raymond RE; et al. (2000). "Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials. Improve Long-term Outcome with abciximab GP IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibition in STENTing". Ann Thorac Surg. 70 (2): 516–26. PMID 10969673.
  23. ↑ Mangano DT, Multicenter Study of Perioperative Ischemia Research Group (2002). "Aspirin and mortality from coronary bypass surgery". N Engl J Med. 347 (17): 1309–17. doi:10.1056/NEJMoa020798. PMID 12397188.
  24. ↑ Antithrombotic Trialists' Collaboration (2002). "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients". BMJ. 324 (7329): 71–86. PMC 64503. PMID 11786451. Review in: ACP J Club. 2002 Jul-Aug;137(1):5
  25. ↑ Dyke CM, Bhatia D, Lorenz TJ, Marso SP, Tardiff BE, Hogeboom C; et al. (2000). "Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: results from PURSUIT. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy". Ann Thorac Surg. 70 (3): 866–71, discussion 871-2. PMID 11016325.
  26. ↑ 26.0 26.1 Clark SC, Vitale N, Zacharias J, Forty J (2000). "Effect of low molecular weight heparin (fragmin) on bleeding after cardiac surgery". Ann Thorac Surg. 69 (3): 762–4, discussion 764-5. PMID 10750757.
  27. ↑ 27.0 27.1 Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M; et al. (2002). "Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports". Circulation. 106 (12 Suppl 1): I19–22. PMID 12354703.
  28. ↑ 28.0 28.1 Kincaid EH, Monroe ML, Saliba DL, Kon ND, Byerly WG, Reichert MG (2003). "Effects of preoperative enoxaparin versus unfractionated heparin on bleeding indices in patients undergoing coronary artery bypass grafting". Ann Thorac Surg. 76 (1): 124–8, discussion 128. PMID 12842525.
  29. ↑ MICHELANGELO OASIS 5 Steering Committee. Mehta SR, Yusuf S, Granger CB, Wallentin L, Peters RJ; et al. (2005). "Design and rationale of the MICHELANGELO Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS)-5 trial program evaluating fondaparinux, a synthetic factor Xa inhibitor, in patients with non-ST-segment elevation acute coronary syndromes". Am Heart J. 150 (6): 1107. doi:10.1016/j.ahj.2005.09.025. PMID 16338245.
  30. ↑ 30.0 30.1 Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J; et al. (2006). "Comparison of fondaparinux and enoxaparin in acute coronary syndromes". N Engl J Med. 354 (14): 1464–76. doi:10.1056/NEJMoa055443. PMID 16537663. Review in: ACP J Club. 2006 Sep-Oct;145(2):30-1
  31. ↑ Stone GW, Bertrand M, Colombo A, Dangas G, Farkouh ME, Feit F; et al. (2004). "Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale". Am Heart J. 148 (5): 764–75. doi:10.1016/j.ahj.2004.04.036. PMID 15523305.
  32. ↑ Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW; et al. (2006). "Bivalirudin for patients with acute coronary syndromes". N Engl J Med. 355 (21): 2203–16. doi:10.1056/NEJMoa062437. PMID 17124018.
  33. ↑ Boersma E, Harrington RA, Moliterno DJ, White H, Théroux P, Van de Werf F; et al. (2002). "Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials". Lancet. 359 (9302): 189–98. doi:10.1016/S0140-6736(02)07442-1. PMID 11812552. Review in: ACP J Club. 2002 Jul-Aug;137(1):2
  34. ↑ Kim JH, Newby LK, Clare RM, Shaw LK, Lodge AJ, Smith PK; et al. (2008). "Clopidogrel use and bleeding after coronary artery bypass graft surgery". Am Heart J. 156 (5): 886–92. doi:10.1016/j.ahj.2008.06.034. PMID 19061702.
  35. ↑ Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA (2004). "Aspirin sensitivity: implications for patients with coronary artery disease". JAMA. 292 (24): 3017–23. doi:10.1001/jama.292.24.3017. PMID 15613671.
  36. ↑ von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A (2005). "Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial". Circulation. 112 (19): 2946–50. doi:10.1161/CIRCULATIONAHA.105.559088. PMID 16260639.
  37. ↑ Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G (2005). "Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study". Circulation. 111 (16): 2099–106. doi:10.1161/01.CIR.0000161383.06692.D4. PMID 15750189.
  38. ↑ Montalescot G, Sideris G, Meuleman C, Bal-dit-Sollier C, Lellouche N, Steg PG; et al. (2006). "A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial". J Am Coll Cardiol. 48 (5): 931–8. doi:10.1016/j.jacc.2006.04.090. PMID 16949482.
  39. ↑ Knudtson ML, Flintoft VF, Roth DL, Hansen JL, Duff HJ (1990). "Effect of short-term prostacyclin administration on restenosis after percutaneous transluminal coronary angioplasty". J Am Coll Cardiol. 15 (3): 691–7. PMID 2105988.
  40. ↑ Roe MT, Granger CB, Puma JA, Hellkamp AS, Hochman JS, Ohman EM; et al. (2001). "Comparison of benefits and complications of hirudin versus heparin for patients with acute coronary syndromes undergoing early percutaneous coronary intervention". Am J Cardiol. 88 (12): 1403–6, A6. PMID 11741559.
  41. ↑ Mahaffey KW, Ferguson JJ (2005). "Exploring the role of enoxaparin in the management of high-risk patients with non-ST-elevation acute coronary syndromes: the SYNERGY trial". Am Heart J. 149 (4 Suppl): S81–90. doi:10.1016/j.ahj.2005.02.023. PMID 16124952.
  42. ↑ Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S; et al. (2004). "Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial". JAMA. 292 (1): 45–54. doi:10.1001/jama.292.1.45. PMID 15238590.
  43. ↑ 43.0 43.1 Sosnowski C (2007). "[Commentary to the article: Stone GW, Bertrand ME, Moses JW et al. Routine upstream initiation vs deferred selective use of glycoprotein IIB/III inhibitors in acute coronary syndromes: the ACUITY Timing trial JAMA 2007: 591-602]". Kardiol Pol. 65 (3): 327–31, discussion 332-3. PMID 17619281.
  44. ↑ Mehta SR, Granger CB, Boden WE, Steg PG, Bassand JP, Faxon DP; et al. (2009). "Early versus delayed invasive intervention in acute coronary syndromes". N Engl J Med. 360 (21): 2165–75. doi:10.1056/NEJMoa0807986. PMID 19458363.
  45. ↑ Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT; et al. (2007). "Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial". Lancet. 369 (9565): 907–19. doi:10.1016/S0140-6736(07)60450-4. PMID 17368152.
  46. ↑ White H, Hirulog and Early Reperfusion or Occlusion (HERO)-2 Trial Investigators (2001). "Thrombin-specific anticoagulation with bivalirudin versus heparin in patients receiving fibrinolytic therapy for acute myocardial infarction: the HERO-2 randomised trial". Lancet. 358 (9296): 1855–63. PMID 11741625.
  47. ↑ Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD; et al. (2004). "Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial". JAMA. 292 (6): 696–703. doi:10.1001/jama.292.6.696. PMID 15304466.
  48. ↑ CAPRIE Steering Committee (1996). "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee". Lancet. 348 (9038): 1329–39. PMID 8918275.
  49. ↑ Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE; et al. (2006). "Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events". N Engl J Med. 354 (16): 1706–17. doi:10.1056/NEJMoa060989. PMID 16531616. Review in: ACP J Club. 2006 Sep-Oct;145(2):33 Review in: Evid Based Med. 2006 Oct;11(5):143
  50. ↑ 50.0 50.1 50.2 de Winter RJ, Windhausen F, Cornel JH, Dunselman PH, Janus CL, Bendermacher PE; et al. (2005). "Early invasive versus selectively invasive management for acute coronary syndromes". N Engl J Med. 353 (11): 1095–104. doi:10.1056/NEJMoa044259. PMID 16162880. Review in: ACP J Club. 2006 Mar-Apr;144(2):30
  51. ↑ 51.0 51.1 Luchi RJ, Scott SM, Deupree RH (1987). "Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study". N Engl J Med. 316 (16): 977–84. doi:10.1056/NEJM198704163161603. PMID 2882420.
  52. ↑ 52.0 52.1 Peterson ED, Shaw LJ, Califf RM (1997). "Risk stratification after myocardial infarction". Ann Intern Med. 126 (7): 561–82. PMID 9092324.
  53. ↑ 53.0 53.1 Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976). "The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions". Circulation. 54 (6 Suppl): III107–17. PMID 791537.
  54. ↑ "Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group". Lancet. 343 (8893): 311–22. 1994. PMID 7905143.
  55. ↑ Kastrati A, Mehilli J, Neumann FJ, Dotzer F, ten Berg J, Bollwein H; et al. (2006). "Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial". JAMA. 295 (13): 1531–8. doi:10.1001/jama.295.13.joc60034. PMID 16533938. Review in: ACP J Club. 2006 Jul-Aug;145(1):8
  56. ↑ Bonello L, Camoin-Jau L, Armero S, Com O, Arques S, Burignat-Bonello C; et al. (2009). "Tailored clopidogrel loading dose according to platelet reactivity monitoring to prevent acute and subacute stent thrombosis". Am J Cardiol. 103 (1): 5–10. doi:10.1016/j.amjcard.2008.08.048. PMID 19101221.
  57. ↑ Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Ruven HJ, Bal ET; et al. (2010). "Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation". JAMA. 303 (8): 754–62. doi:10.1001/jama.2010.181. PMID 20179285.
  58. ↑ Marcucci R, Gori AM, Paniccia R, Giusti B, Valente S, Giglioli C; et al. (2009). "Cardiovascular death and nonfatal myocardial infarction in acute coronary syndrome patients receiving coronary stenting are predicted by residual platelet reactivity to ADP detected by a point-of-care assay: a 12-month follow-up". Circulation. 119 (2): 237–42. doi:10.1161/CIRCULATIONAHA.108.812636. PMID 19118249.
  59. ↑ Matetzky S, Shenkman B, Guetta V, Shechter M, Beinart R, Bienart R; et al. (2004). "Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction". Circulation. 109 (25): 3171–5. doi:10.1161/01.CIR.0000130846.46168.03. PMID 15184279.
  60. ↑ Sofi F, Marcucci R, Gori AM, Giusti B, Abbate R, Gensini GF (2010). "Clopidogrel non-responsiveness and risk of cardiovascular morbidity. An updated meta-analysis". Thromb Haemost. 103 (4): 841–8. doi:10.1160/TH09-06-0418. PMID 20135063.
  61. ↑ Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT; et al. (2009). "Cytochrome p-450 polymorphisms and response to clopidogrel". N Engl J Med. 360 (4): 354–62. doi:10.1056/NEJMoa0809171. PMID 19106084.
  62. ↑ Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM (2010). "ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". J Am Coll Cardiol. 56 (4): 321–41. doi:10.1016/j.jacc.2010.05.013. PMID 20633831.
  63. ↑ Collet JP, Hulot JS, Pena A, Villard E, Esteve JB, Silvain J; et al. (2009). "Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study". Lancet. 373 (9660): 309–17. doi:10.1016/S0140-6736(08)61845-0. PMID 19108880.
  64. ↑ Giusti B, Gori AM, Marcucci R, Saracini C, Sestini I, Paniccia R; et al. (2009). "Relation of cytochrome P450 2C19 loss-of-function polymorphism to occurrence of drug-eluting coronary stent thrombosis". Am J Cardiol. 103 (6): 806–11. doi:10.1016/j.amjcard.2008.11.048. PMID 19268736.
  65. ↑ Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Méneveau N; et al. (2009). "Genetic determinants of response to clopidogrel and cardiovascular events". N Engl J Med. 360 (4): 363–75. doi:10.1056/NEJMoa0808227. PMID 19106083.
  66. ↑ Trenk D, Hochholzer W, Fromm MF, Chialda LE, Pahl A, Valina CM; et al. (2008). "Cytochrome P450 2C19 681G>A polymorphism and high on-clopidogrel platelet reactivity associated with adverse 1-year clinical outcome of elective percutaneous coronary intervention with drug-eluting or bare-metal stents". J Am Coll Cardiol. 51 (20): 1925–34. doi:10.1016/j.jacc.2007.12.056. PMID 18482659.
  67. ↑ Shuldiner AR, O'Connell JR, Bliden KP, Gandhi A, Ryan K, Horenstein RB; et al. (2009). "Association of cytochrome P450 2C19 genotype with the antiplatelet effect and clinical efficacy of clopidogrel therapy". JAMA. 302 (8): 849–57. doi:10.1001/jama.2009.1232. PMID 19706858.

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