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| | #redirect:[[Non ST elevation myocardial infarction antiplatelet therapy]] |
| {{WikiDoc Cardiology Network Infobox}}
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| {{Editor Join}}
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| ==Overview of Immediate Management in NSTEMI==
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| ==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>==
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| ===Class I===
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| # [[Aspirin]] should be administered to [[UA]] / [[NSTEMI]] patients as soon as possible after hospital presentation and continued indefinitely in patients not known to be intolerant of that medication. (Level of Evidence: A) | |
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| # [[Clopidogrel]] (loading dose followed by daily maintenance dose) should be administered to [[UA]] / [[NSTEMI]] patients who are unable to take [[ASA]] because of hypersensitivity or major gastrointestinal intolerance. (Level of Evidence: A)
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| # In [[UA]] / [[NSTEMI]] patients with a history of [[gastrointestinal bleeding]], when [[ASA]] and [[clopidogrel]] are administered alone or in combination, drugs to minimize the risk of recurrent [[gastrointestinal bleeding]] (e.g., [[proton pump inhibitor]]s) should be prescribed concomitantly. (Level of Evidence: B)
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial invasive strategy is selected, [[antiplatelet therapy]] in addition to [[aspirin]] should be initiated before diagnostic angiography (upstream) with either [[clopidogrel]] (loading dose followed by daily maintenance dose) or an intravenous [[GP IIb/IIIa inhibitor]]. (Level of Evidence: A) [[Abciximab]] as the choice for upstream GP IIb/IIIa therapy is indicated only if there is no appreciable delay to angiography and PCI is likely to be performed; otherwise, IV [[eptifibatide]] or [[tirofiban]] is the preferred choice of GP IIb/IIIa inhibitor. (Level of Evidence: B)
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial conservative (i.e., noninvasive) strategy is selected, [[clopidogrel]] (loading dose followed by daily maintenance dose) should be added to [[ASA]] and [[anticoagulant therapy]] as soon as possible after admission and administered for at least 1 month (Level of Evidence: A) and ideally up to 1 year. (Level of Evidence: B)
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial conservative strategy is selected, if recurrent symptoms/[[ischemia]], [[HF]], or serious arrhythmias subsequently appear, then diagnostic angiography should be performed. (Level of Evidence: A) Either an intravenous GP IIb/IIIa inhibitor ([[eptifibatide]] or [[tirofiban]]; Level of Evidence: A) or [[clopidogrel]] (loading dose followed by daily maintenance dose; Level of Evidence: A) should be added to [[ASA]] and [[anticoagulant therapy]] before diagnostic angiography (upstream).(Level of Evidence: C)
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| ===Class IIa===
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial conservative strategy is selected and who have recurrent ischemic discomfort with [[clopidogrel]], [[ASA]], and [[anticoagulant therapy]], it is reasonable to add a [[GP IIb/IIIa antagonist]] before [[diagnostic angiography]]. (Level of Evidence: C)
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial invasive strategy is selected, it is reasonable to initiate [[antiplatelet therapy]] with both [[clopidogrel]] (loading dose followed by daily maintenance dose) and an intravenous [[GP IIb/IIIa inhibitor]]. (Level of Evidence: B) [[Abciximab]] as the choice for upstream [[GP IIb/IIIa]] therapy is indicated only if there is no appreciable delay to [[coronary angiography]] and [[PCI]] is likely to be performed; otherwise, IV [[eptifibatide]] or [[tirofiban]] is the preferred choice of [[GP IIb/IIIa inhibitor]]. (Level of Evidence: B)
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial invasive strategy is selected, it is reasonable to omit upstream administration of an intravenous [[GP IIb/IIIa antagonist]] before [[diagnostic angiography]] if [[bivalirudin]] is selected as the [[anticoagulant]] and at least 300 mg of [[clopidogrel]] was administered at least 6 h earlier than planned [[cardiac catheterization|catheterization]] or [[PCI]]. (Level of Evidence: B)
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| ===Class IIb===
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| # For [[UA]] / [[NSTEMI]] patients in whom an initial conservative (i.e., noninvasive) strategy is selected, it may be reasonable to add [[eptifibatide]] or [[tirofiban]] to [[anticoagulant therapy|anticoagulant]] and oral [[antiplatelet therapy]]. (Level of Evidence: B)
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| ===Class III===
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| # [[Abciximab]] should not be administered to patients in whom [[PCI]] is not planned. (Level of Evidence: A)
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| ==Sources==
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| *The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Eleveation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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