Coronary heart disease secondary prevention antiplatelet agents/anticoagulants: Difference between revisions
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<nowiki>"</nowiki>'''6.''' Antiplatelet therapy is recommended in preference to anticoagulant therapy with warfarin or other vitamin K antagonists to treat patients with atherosclerosis. | <nowiki>"</nowiki>'''6.''' Antiplatelet therapy is recommended in preference to anticoagulant therapy with warfarin or other vitamin K antagonists to treat patients with atherosclerosis. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]]) | ||
::*If there is a compelling indication for anticoagulant therapy, such as atrial fibrillation, prosthetic heart valve, left ventricular thrombus, or concomitant venous thromboembolic disease, warfarin should be administered in addition to the low-dose aspirin (75–81 mg daily). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]]) | ::*If there is a compelling indication for anticoagulant therapy, such as atrial fibrillation, prosthetic heart valve, left ventricular thrombus, or concomitant venous thromboembolic disease, warfarin should be administered in addition to the low-dose aspirin (75–81 mg daily). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]]) | ||
::*For patients requiring warfarin, therapy should be administered to achieve the recommended INR for the specific condition. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]]) | ::*For patients requiring warfarin, therapy should be administered to achieve the recommended INR for the specific condition. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]]) | ||
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<nowiki>"</nowiki>2. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]]<nowiki>"</nowiki> | <nowiki>"</nowiki>2. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]]<nowiki>"</nowiki> | ||
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Revision as of 16:43, 11 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Type 2 Diabetes Mellitus Management
ACC / AHA 2011 Guidelines - Coronary Heart Disease - Secondary Prevention with Diabetes Mellitus Management (DO NOT EDIT) [1]
| Class I |
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"1. Aspirin 75–162 mg daily is recommended in all patients with coronary artery disease unless contraindicated. (Level A)
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"2. A P2Y12 receptor antagonist in combination with aspirin is indicated in patients after ACS or PCI with stent placement. (Level A)
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"3. For patients undergoing coronary artery bypass grafting, aspirin should be started within 6 hours after surgery to reduce saphenous vein graft closure. Dosing regimens ranging from 100 to 325 mg daily for 1 year appear to be efficacious. (Level A)" |
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"4. In patients with extracranial carotid or vertebral atherosclerosis who have had ischemic stroke or TIA, treatment with aspirin alone (75–325 mg daily), clopidogrel alone (75 mg daily), or the combination of aspirin plus extended-release dipyridamole (25 mg and 200 mg twice daily, respectively) should be started and continued. (Level B)" |
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"5. For patients with symptomatic atherosclerotic peripheral artery disease of the lower extremity, antiplatelet therapy with aspirin (75–325 mg daily) or clopidogrel (75 mg daily) should be started and continued. (Level A)" |
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"6. Antiplatelet therapy is recommended in preference to anticoagulant therapy with warfarin or other vitamin K antagonists to treat patients with atherosclerosis. (Level A)
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| Class IIa |
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"1. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by thienopyridine therapy after stent implantation, earlier discontinuation (eg, <12 months) is reasonable. (Level C) (Note: the risk for serious cardiovascular events because of early discontinuation of thienopyridines is greater for patients with drug-eluting stents than those with bare-metal stents.)" |
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"2. After PCI, it is reasonable to use 81 mg of aspirin per day in preference to higher maintenance doses. (Level B)" |
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"3. For patients undergoing coronary artery bypass grafting, clopidogrel (75 mg daily) is a reasonable alternative in patients who are intolerant of or allergic to aspirin. (Level C)" |
| Class IIb |
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"1. The benefits of aspirin in patients with asymptomatic peripheral artery disease of the lower extremities are not well established. (Level B)" |
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"2. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. (Level B" |
References
- ↑ Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.