Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy: Difference between revisions
Esther Lee (talk | contribs) (/* 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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{{Unstable angina / NSTEMI}} | {{Unstable angina / NSTEMI}} | ||
{{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | {{CMG}}; '''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<ref name="pmid22800849">{{cite journal| author=2012 Writing Committee Members. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR et al.| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 875-910 | pmid=22800849 | doi=10.1161/CIR.0b013e318256f1e0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800849 }} </ref> (DO NOT EDIT)== | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For [[UA]]/[[NSTEMI]] patients treated medically without [[stent]]ing, [[aspirin]] (75 to 162 mg per day) should be prescribed indefinitely ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) [[clopidogrel]] (75 mg per day) should be prescribed for at least 1 month and ideally for up to 1 year. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) | |||
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'''1.''' [[Dipyridamole]] is not recommended as an [[antiplatelet]] agent in post-[[UA]]/[[NSTEMI]] patients because it has not been shown to be effective. | {|class="wikitable" | ||
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |||
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|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Dipyridamole]] is not recommended as an [[antiplatelet]] agent in post-[[UA]]/[[NSTEMI]] patients because it has not been shown to be effective. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]=== |
Revision as of 14:55, 5 October 2012
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
Special Groups |
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 |
Mechanical Reperfusion |
Discharge Care |
Case Studies |
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 (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 (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 IIa1. 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 IIb1. 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 AlsoSources
References
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