Unstable angina / non ST elevation myocardial infarction antiplatelet therapy recommendations: Difference between revisions
(/* ACC / AHA Guidelines for Antiplatelet therapy in Unstable Angina/NSTEMI (DO NOT EDIT) {{cite journal |author=Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippi...) |
(/* ACC / AHA Guidelines for Antiplatelet therapy in Unstable Angina/NSTEMI (DO NOT EDIT) {{cite journal |author=Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippi...) |
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' For UA/NSTEMI patients in whom an initial conservative strategy is selected, if recurrent symptoms/ischemia, heart failure, or serious arrhythmias subsequently appear, then diagnostic angiography should be performed. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) Either an IV GP IIb/IIIa inhibitor (eptifibatide or tirofiban {[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]}), clopidogrel (loading dose followed by daily maintenance dose | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' For UA/NSTEMI patients in whom an initial conservative strategy is selected, if recurrent symptoms/ischemia, heart failure, or serious arrhythmias subsequently appear, then diagnostic angiography should be performed. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) Either an IV GP IIb/IIIa inhibitor (eptifibatide or tirofiban {[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]}), clopidogrel (loading dose followed by daily maintenance dose {[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]}), or ticagrelor (loading dose followed by daily maintenance dose {[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]}) should be added to aspirin and anticoagulant therapy before diagnostic angiography (upstream). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | ||
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Revision as of 20:09, 4 October 2012
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
Special Groups |
Diagnosis |
Laboratory Findings |
Treatment |
Antitplatelet Therapy |
Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
Mechanical Reperfusion |
Discharge Care |
Case Studies |
Unstable angina / non ST elevation myocardial infarction antiplatelet therapy recommendations On the Web |
FDA on Unstable angina / non ST elevation myocardial infarction antiplatelet therapy recommendations |
CDC onUnstable angina / non ST elevation myocardial infarction antiplatelet therapy recommendations |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Antiplatelet therapy recommendations
ACC / AHA Guidelines for Antiplatelet therapy in Unstable Angina/NSTEMI (DO NOT EDIT) [1]
Class I |
"1. Aspirin should be administered to Unstable angina/NSTEMI patients as soon as possible after hospital presentation and continued indefinitely in patients who tolerate it. (Level of Evidence: A) " |
"2. A loading dose followed by daily maintenance dose of either clopidogrel (Level of Evidence: B), prasugrel (in PCI-treated patients) (Level of Evidence: C), or ticagrelor (Level of Evidence: C) should be administered to UA/NSTEMI patients who are unable to take aspirin because of hypersensitivity or major GI intolerance. " |
"3. Patients with definite UA/NSTEMI at medium or high risk and in whom an initial invasive strategy is selected should receive dual antiplatelet therapy on presentation. (Level of Evidence: A) Aspirin should be initiated on presentation. (Level of Evidence: A) The choice of a second antiplatelet therapy to be added to aspirin on presentation includes 1 of the following (note that there are no data for therapy with 2 concurrent P2Y12 receptor inhibitors, and this is not recommended in the case of aspirin allergy):
a.Before PCI:
b.At the time of PCI:
|
"4.For UA/NSTEMI patients in whom an initial conservative (ie, noninvasive) strategy is selected, clopidogrel or ticagrelor (loading dose followed by daily maintenance dose) should be added to aspirin and anticoagulant therapy as soon as possible after admission and administered for up to 12 months. (Level of Evidence: B) " |
"5. For UA/NSTEMI patients in whom an initial conservative strategy is selected, if recurrent symptoms/ischemia, heart failure, or serious arrhythmias subsequently appear, then diagnostic angiography should be performed. (Level of Evidence: A) Either an IV GP IIb/IIIa inhibitor (eptifibatide or tirofiban {Level of Evidence: A}), clopidogrel (loading dose followed by daily maintenance dose {Level of Evidence: B}), or ticagrelor (loading dose followed by daily maintenance dose {Level of Evidence: B}) should be added to aspirin and anticoagulant therapy before diagnostic angiography (upstream). (Level of Evidence: C) " |
"6. A loading dose of P2Y12 receptor inhibitor therapy is recommended for UA/NSTEMI patients for whom PCI is planned. One of the following regimens should be used:
a. Clopidogrel 600 mg should be given as early as possible before or at the time of PCI (Level of Evidence: B) or b. Prasugrel 60 mg should be given promptly and no later than 1 hour after PCI once coronary anatomy is defined and a decision is made to proceed with PCI (Level of Evidence: B) or c. Ticagrelor 180 mg should be given as early as possible before or at the time of PCI. (Level of Evidence: B) " |
"7. The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows:
a. In UA/NSTEMI patients undergoing PCI, either clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice daily should be given for at least 12 months. (Level of Evidence: B) b. If the risk of morbidity because of bleeding outweighs the anticipated benefits afforded by P2Y12 receptor inhibitor therapy, earlier discontinuation should be considered. (Level of Evidence: C) |
References
- ↑ Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP (2011). "2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31820f2f3e. PMID 21444889. Retrieved 2011-03-30. Unknown parameter
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