Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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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 |
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Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet 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.
ACC / AHA Guidelines for Convalescent and Long-Term Antiplatelet Therapy[1] (DO NOT EDIT)
Class I |
"1. For UA/NSTEMI patients treated medically without stenting, aspirin* should be prescribed indefinitely60,61,63,64 (Level of Evidence: A); clopidogrel (75 mg per day) or ticagrelor† (90 mg twice daily) should be prescribed for up to 12 months.9,10,14 (Level of Evidence: B) " |
"2. For UA/NSTEMI patients treated with a [[stent] (BMS or DES), aspirin should be continued indefinitely. (Level of Evidence: A) The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows:
|
"3. Clopidogrel 75 mg daily13,67 (Level of Evidence: A), prasugrel‡ 10 mg daily (in PCI-treated patients)7 (Level of Evidence: C), or ticagrelor† 90 mg twice daily9 ((Level of Evidence: C)) should be given to patients recovering from UA/NSTEMI when aspirin is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as PPIs).42,68 " |
Class III: No Benefit |
"1. Dipyridamole is not recommended as an antiplatelet agent in post-UA/NSTEMI patients because it has not been shown to be effective. (Level of Evidence: B) " |
Class IIa |
"1. After PCI, it is reasonable to use 81 mg per day of aspirin in preference to higher maintenance doses.32,33,90,127,128 (Level of Evidence: B) " |
Class IIb |
"1. For UA/NSTEMI patients who have an indication for anticoagulation, add warfarin to maintain an international normalization ratio of 2.0 to 3.0. (Level of Evidence: B) " |
"2. Continuation of a P2Y12 receptor inhibitor beyond 12 months may be considered in patients following DES placement. (Level of Evidence: C) " |
See Also
References
- ↑ 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.