Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy: Difference between revisions

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(/* ACC / AHA Guidelines - Antiplatelet Therapy(DO NOT EDIT) {{cite journal |author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wrigh...)
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===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===


'''1.''' For [[UA]]/[[NSTEMI]] patients treated medically without [[stent]]ing,[[aspirin]]'''Φ''' (75 to 162 mg per day) should be prescribed indefinitely ''(Level of Evidence: A)'' [[clopidogrel]]'''†''' (75 mg per day) should be prescribed for at least 1 month and ideally for up to 1 year. ''(Level of Evidence: B)''
'''1.''' For [[UA]]/[[NSTEMI]] patients treated medically without [[stent]]ing,[[aspirin]]'''Φ''' (75 to 162 mg per day) should be prescribed indefinitely ''(Level of Evidence: A)'' [[clopidogrel]]'''†''' (75 mg per day) should be prescribed for at least 1 month and ideally for up to 1 year. ''(Level of Evidence: B)''
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'''2.''' [[Clopidogrel]] 75 mg daily (preferred) or [[ticlopidine]] (in the absence of contraindications) should be given to patients recovering from [[UA]] / [[NSTEMI]] when[[ASA]] is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as [[PPI]]s). (Level of Evidence: A)
'''2.''' [[Clopidogrel]] 75 mg daily (preferred) or [[ticlopidine]] (in the absence of contraindications) should be given to patients recovering from [[UA]] / [[NSTEMI]] when[[ASA]] is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as [[PPI]]s). (Level of Evidence: A)


===Class IIa===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
 
'''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)''
 
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===


'''1.''' For [[UA]]/[[NSTEMI]] patients in whom the [[physician]] is concerned about the risk of bleeding, a lower initial [[aspirin]] dose after [[PCI]] of 75 to 162 mg per day is reasonable. ''(Level of Evidence: C)''
'''1.''' For [[UA]]/[[NSTEMI]] patients in whom the [[physician]] is concerned about the risk of bleeding, a lower initial [[aspirin]] dose after [[PCI]] of 75 to 162 mg per day is reasonable. ''(Level of Evidence: C)''


===Class IIb===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|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)''
'''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 [[clopidogrel]] or [[prasugrel]] beyond 15 months may be considered in patients following [[DES]] placement. (Level of Evidence: C)
'''2.''' Continuation of [[clopidogrel]] or [[prasugrel]] beyond 15 months may be considered in patients following [[DES]] placement. (Level of Evidence: C)
===Class III===
'''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)''


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Revision as of 18:26, 1 October 2012

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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 - Antiplatelet Therapy(DO NOT EDIT) [1][2]

“

Class I

1. For UA/NSTEMI patients treated medically without stenting,aspirinΦ (75 to 162 mg per day) should be prescribed indefinitely (Level of Evidence: A) clopidogrel† (75 mg per day) should be prescribed for at least 1 month and ideally for up to 1 year. (Level of Evidence: B)

2. Clopidogrel 75 mg daily (preferred) or ticlopidine (in the absence of contraindications) should be given to patients recovering from UA / NSTEMI whenASA is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as PPIs). (Level of Evidence: A)

Class III

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. For UA/NSTEMI patients in whom the physician is concerned about the risk of bleeding, a lower initial aspirin dose after PCI of 75 to 162 mg per day is reasonable. (Level of Evidence: C)

Class IIb

1. For UA/NSTEMI patients who have an indication for anticoagulation, addwarfarin‡ to maintain an international normalization ratio of 2.0 to 3.0.§(Level of Evidence: B)

2. Continuation of clopidogrel or prasugrel beyond 15 months may be considered in patients following DES placement. (Level of Evidence: C)

Φ In patients allergic to ASA, clopidogrel alone can be used or ASA desensitization can be tried.

† For patients allergic to clopidogrel, ticlopidine 250mg orally twice daily is recommended.

‡ Continue ASA indefinitely and warfarin longer term as indicated for specific conditions such as atrial fibrillation; LV thrombus; or cerebral, venous, or pulmonary emboli.

§ An INR of 2.0 to 2.5 is preferable while given with ASA and clopidogrel, especially in older patients and those with other risk factors for bleeding. For UA/NSTEMI patients who have mechanical heart valves, the INR should be at least 2.5 (based on type of prosthesis).

”

See Also

Sources

References

  1. ↑ Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS (2011). "2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B (2007). "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 of the American College ofCardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)
  3. ↑ 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 2011-03-31. Unknown parameter |month= ignored (help)

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