Post PCI management
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Stable Angina
Unstable Angina
Non ST Elevation MI
ST Elevation MI
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention: Post-procedural Antiplatelet Therapy [1] (DO NOT EDIT)
| Class I |
| "1. After PCI, use of aspirin should be continued indefinitely.[2][3][4][5] (Level of Evidence: A)" |
"2. The duration of P2Y12 inhibitor therapy after stent implantation should generally be as follows:
|
| "3. Patients should be counseled on the importance of compliance with dual antiplatelet therapy (DAPT) and that therapy should not be discontinued before discussion with their cardiologist.[11] (Level of Evidence: C)" |
| Class III (No Benefit) |
| "1. Continuation of clopidogrel, prasugrel or ticagrelor beyond 12 months may be considered in patients undergoing placement of drug eluting stent (DES).[7][8] (Level of Evidence: C)" |
| Class IIa |
| "1. After PCI, it is reasonable to use aspirin 81 mg per day in preference to higher maintenance doses.[13][14][15][16][17] (Level of Evidence: B)" |
| "2. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of P2Y12 inhibitor therapy after stent implantation, earlier discontinuation (e.g., less than 12 months) of P2Y12 inhibitor therapy is reasonable. (Level of Evidence: C)" |
ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention: Post-Procedural Proton Pump Inhibitors and Anti-platelet Therapy[1] (DO NOT EDIT)
| Class I |
| "1. Proton pump inhibitors should be used in patients with a history of prior gastrointestinal bleeding who require dual antiplatelet therapy (DAPT).[18] (Level of Evidence: C)" |
| Class III (No Benefit) |
| "1. Routine use of a proton pump inhibitor is not recommended for patients at low risk of gastrointestinal bleeding, who have much less potential to benefit from prophylactic therapy.[18] (Level of Evidence: C)" |
| Class IIa |
| "1. Use of proton pump inhibitors is reasonable in patients with an increased risk of gastrointestinal bleeding (e.g., advanced age, concomitant use of warfarin, steroids, nonsteroidal antiinflammatory drugs, Helicobacter pylori infection) who require dual antiplatelet therapy (DAPT).[18] (Level of Evidence: C)" |
ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention: Post-Procedural Clopidogrel Genetic Testing[1] (DO NOT EDIT)
| Class III (No Benefit) |
| "1. The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[19] (Level of Evidence: C)" |
| Class IIb |
| "1. Genetic testing might be considered to identify whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhibition with clopidogrel.[19] (Level of Evidence: C)" |
| "2. When a patient predisposed to inadequate platelet inhibition with clopidogrel is identified by genetic testing, treatment with an alternate P2Y12 inhibitor (e.g., prasugrel or ticagrelor) might be considered.[19] (Level of Evidence: C)" |
ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention: Post-Procedural Platelet Function Testing[1] (DO NOT EDIT)
| Class III (No Benefit) |
| "1. The routine clinical use of platelet function testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[19] (Level of Evidence: C)" |
| Class IIb |
| "1. Platelet function testing may be considered in patients at high risk for poor clinical outcomes.[19] (Level of Evidence: C)" |
| "2. In patients treated with clopidogrel with high platelet reactivity, alternative agents, such as prasugrel or ticagrelor, might be considered.[19] (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 1.2 1.3 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter
|month=ignored (help) - ↑ Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann-Roth EM, Richardt G, Alt E, Schmitt C, Ulm K (1996). "A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents". The New England Journal of Medicine. 334 (17): 1084–9. doi:10.1056/NEJM199604253341702. PMID 8598866. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients". BMJ (Clinical Research Ed.). 324 (7329): 71–86. 2002. PMC 64503. PMID 11786451. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA (2006). "AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute". Circulation. 113 (19): 2363–72. doi:10.1161/CIRCULATIONAHA.106.174516. PMID 16702489. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A (2009). "Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials". Lancet. 373 (9678): 1849–60. doi:10.1016/S0140-6736(09)60503-1. PMC 2715005. PMID 19482214. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA (2001). "Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study". Lancet. 358 (9281): 527–33. PMID 11520521. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". The New England Journal of Medicine. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M (2009). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes". The New England Journal of Medicine. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Brar SS, Kim J, Brar SK, Zadegan R, Ree M, Liu IL, Mansukhani P, Aharonian V, Hyett R, Shen AY (2008). "Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions". Journal of the American College of Cardiology. 51 (23): 2220–7. doi:10.1016/j.jacc.2008.01.063. PMID 18534267. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM (2007). "Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation". JAMA : the Journal of the American Medical Association. 297 (2): 159–68. doi:10.1001/jama.297.2.joc60179. PMID 17148711. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ 11.0 11.1 Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P (2007). "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians". Journal of the American College of Cardiology. 49 (6): 734–9. doi:10.1016/j.jacc.2007.01.003. PMID 17291948. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C, Topol EJ (2002). "Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial". JAMA : the Journal of the American Medical Association. 288 (19): 2411–20. PMID 12435254. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Jolly SS, Pogue J, Haladyn K, Peters RJ, Fox KA, Avezum A, Gersh BJ, Rupprecht HJ, Yusuf S, Mehta SR (2009). "Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study". European Heart Journal. 30 (8): 900–7. doi:10.1093/eurheartj/ehn417. PMID 18819961. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Patrono C, Baigent C, Hirsh J, Roth G (2008). "Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 199S–233S. doi:10.1378/chest.08-0672. PMID 18574266. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Steinhubl SR, Bhatt DL, Brennan DM, Montalescot G, Hankey GJ, Eikelboom JW, Berger PB, Topol EJ (2009). "Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding". Annals of Internal Medicine. 150 (6): 379–86. PMID 19293071. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Baggish JS, Bhatt DL, Topol EJ (2005). "Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials". The American Journal of Cardiology. 95 (10): 1218–22. doi:10.1016/j.amjcard.2005.01.049. PMID 15877994. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, Diaz R, Commerford PJ, Valentin V, Yusuf S (2003). "Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study". Circulation. 108 (14): 1682–7. doi:10.1161/01.CIR.0000091201.39590.CB. PMID 14504182. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ 18.0 18.1 18.2 Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF (2010). "ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Journal of the American College of Cardiology. 56 (24): 2051–66. doi:10.1016/j.jacc.2010.09.010. PMID 21126648. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ 19.0 19.1 19.2 19.3 19.4 19.5 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". Journal of the American College of Cardiology. 56 (4): 321–41. doi:10.1016/j.jacc.2010.05.013. PMID 20633831. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help)