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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(/* Convalescent and Long-Term Antiplatelet Therapy (DO NOT EDIT){{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 Manage...)
(/* Convalescent and Long-Term Antiplatelet Therapy (DO NOT EDIT){{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 Manage...)
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| 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* should be prescribed indefinitely ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''; [[clopidogrel]] (75 mg per day) or [[ticagrelor]]** (90 mg twice daily) should be prescribed for up to 12 months. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For [[UA/NSTEMI]] patients treated medically without [[stent]]ing, aspirin* should be prescribed indefinitely<ref name="pmid19482214">{{cite journal| author=Antithrombotic Trialists' (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J et al.| title=Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. | journal=Lancet | year= 2009 | volume= 373 | issue= 9678 | pages= 1849-60 | pmid=19482214 | doi=10.1016/S0140-6736(09)60503-1 | pmc=PMC2715005 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19482214  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19755350 Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-4, JC3-5]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949174 Review in: Evid Based Med. 2009 Dec;14(6):172-3] </ref><ref name="pmid3903504">{{cite journal| author=Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA et al.| title=Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. | journal=N Engl J Med | year= 1985 | volume= 313 | issue= 22 | pages= 1369-75 | pmid=3903504 | doi=10.1056/NEJM198511283132201 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3903504  }} </ref><ref name="pmid6135989">{{cite journal| author=Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE et al.| title=Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. | journal=N Engl J Med | year= 1983 | volume= 309 | issue= 7 | pages= 396-403 | pmid=6135989 | doi=10.1056/NEJM198308183090703 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6135989  }} </ref><ref name="pmid9077376">{{cite journal| author=Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH| title=Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 14 | pages= 973-9 | pmid=9077376 | doi=10.1056/NEJM199704033361401 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9077376  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''; [[clopidogrel]] (75 mg per day) or [[ticagrelor]]** (90 mg twice daily) should be prescribed for up to 12 months.<ref name="pmid19717846">{{cite journal| author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C et al.| title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 11 | pages= 1045-57 | pmid=19717846 | doi=10.1056/NEJMoa0904327 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717846  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20008753 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4] </ref><ref name="pmid21685437">{{cite journal| author=James SK, Roe MT, Cannon CP, Cornel JH, Horrow J, Husted S et al.| title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial. | journal=BMJ | year= 2011 | volume= 342 | issue=  | pages= d3527 | pmid=21685437 | doi=10.1136/bmj.d3527 | pmc=PMC3117310 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21685437  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For [[UA/NSTEMI]] patients treated with a [[stent]] (BMS or DES), aspirin should be continued indefinitely. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows:
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For [[UA/NSTEMI]] patients treated with a [[stent]] (BMS or DES), aspirin should be continued indefinitely. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows:
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'''a)''' [[Clopidogrel]] 75 mg daily, [[prasugrel]]*** 10 mg daily, or [[ticagrelor]]** 90 mg twice daily should be given for at least 12 months in patients receiving [[DES]] and up to 12 months for patients receiving [[BMS]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
'''a)''' [[Clopidogrel]] 75 mg daily<ref name="pmid11520521">{{cite journal| author=Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK et al.| title=Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. | journal=Lancet | year= 2001 | volume= 358 | issue= 9281 | pages= 527-33 | pmid=11520521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11520521  }} </ref>, [[prasugrel]]*** 10 mg daily<ref name="pmid17982182">{{cite journal| author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S et al.| title=Prasugrel versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 20 | pages= 2001-15 | pmid=17982182 | doi=10.1056/NEJMoa0706482 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17982182  }} </ref>, or [[ticagrelor]]** 90 mg twice daily<ref name="pmid19717846">{{cite journal| author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C et al.| title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 11 | pages= 1045-57 | pmid=19717846 | doi=10.1056/NEJMoa0904327 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717846  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20008753 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4] </ref> should be given for at least 12 months in patients receiving [[DES]] and up to 12 months for patients receiving [[BMS]].<ref name="pmid19717846">{{cite journal| author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C et al.| title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 11 | pages= 1045-57 | pmid=19717846 | doi=10.1056/NEJMoa0904327 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717846  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20008753 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4] </ref><ref name="pmid11519503">{{cite journal| author=Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK et al.| title=Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 7 | pages= 494-502 | pmid=11519503 | doi=10.1056/NEJMoa010746 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11519503  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11874270 Review in: ACP J Club. 2002 Mar-Apr;136(2):45] </ref><ref name="pmid11520521">{{cite journal| author=Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK et al.| title=Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. | journal=Lancet | year= 2001 | volume= 358 | issue= 9281 | pages= 527-33 | pmid=11520521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11520521  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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'''b)''' If the risk of morbidity because of bleeding outweighs the anticipated benefits afforded by P2Y12 receptor inhibitor therapy, earlier discontinuation should be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
'''b)''' If the risk of morbidity because of bleeding outweighs the anticipated benefits afforded by P2Y12 receptor inhibitor therapy, earlier discontinuation should be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Clopidogrel]] 75 mg daily ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'', [[prasugrel]]*** 10 mg daily (in [[PCI]]-treated patients) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'', or [[ticagrelor]] 90 mg twice daily ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' should be given to patients recovering from [[UA/NSTEMI]] when aspirin is contraindicated or not tolerated because of hypersensitivity or [[GI intolerance]] (despite use of gastroprotective agents such as PPIs).<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Clopidogrel]] 75 mg daily<ref name="pmid11519503">{{cite journal| author=Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK et al.| title=Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 7 | pages= 494-502 | pmid=11519503 | doi=10.1056/NEJMoa010746 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11519503  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11874270 Review in: ACP J Club. 2002 Mar-Apr;136(2):45] </ref><ref name="pmid8918275">{{cite journal| author=CAPRIE Steering Committee| title=A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. | journal=Lancet | year= 1996 | volume= 348 | issue= 9038 | pages= 1329-39 | pmid=8918275 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8918275  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'', [[prasugrel]]*** 10 mg daily (in [[PCI]]-treated patients)<ref name="pmid18634190">{{cite journal| author=Sosnowski C| title=[Commentary to the article: Wiviott S D, Braunwald E, McCabe C H et al. Prasugrel versus clopidogrel in patients with acute coronary syndrome. N Engl J Med 2007; 357: 2001-15]. | journal=Kardiol Pol | year= 2008 | volume= 66 | issue= 2 | pages= 222-5; discussion 225-6 | pmid=18634190 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18634190  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'', or [[ticagrelor]] 90 mg twice daily<ref name="pmid19717846">{{cite journal| author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C et al.| title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 11 | pages= 1045-57 | pmid=19717846 | doi=10.1056/NEJMoa0904327 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717846  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20008753 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' should be given to patients recovering from [[UA/NSTEMI]] when aspirin is contraindicated or not tolerated because of hypersensitivity or [[GI intolerance]] (despite use of gastroprotective agents such as PPIs).<ref name="pmid20925534">{{cite journal| author=Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ et al.| title=Clopidogrel with or without omeprazole in coronary artery disease. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 20 | pages= 1909-17 | pmid=20925534 | doi=10.1056/NEJMoa1007964 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20925534  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21558563 Review in: Evid Based Med. 2011 Oct;16(5):144-5]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21403070 Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-7] </ref><ref name="pmid15613671">{{cite journal| author=Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA| title=Aspirin sensitivity: implications for patients with coronary artery disease. | journal=JAMA | year= 2004 | volume= 292 | issue= 24 | pages= 3017-23 | pmid=15613671 | doi=10.1001/jama.292.24.3017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15613671  }} </ref><nowiki>"</nowiki>
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Revision as of 17:08, 8 November 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.

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) (DO NOT EDIT)[1]

Convalescent and Long-Term Antiplatelet Therapy (DO NOT EDIT)[1]

Class I
"1. For UA/NSTEMI patients treated medically without stenting, aspirin* should be prescribed indefinitely[2][3][4][5] (Level of Evidence: A); clopidogrel (75 mg per day) or ticagrelor** (90 mg twice daily) should be prescribed for up to 12 months.[6][7] (Level of Evidence: B)"
"2. For UA/NSTEMI patients treated with a stent (BMS or DES), aspirin should be continued indefinitely. (Level of Evidence: A) The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows:

a) Clopidogrel 75 mg daily[8], prasugrel*** 10 mg daily[9], or ticagrelor** 90 mg twice daily[6] should be given for at least 12 months in patients receiving DES and up to 12 months for patients receiving BMS.[6][10][8] (Level of Evidence: B)

b) If the risk of morbidity because of bleeding outweighs the anticipated benefits afforded by P2Y12 receptor inhibitor therapy, earlier discontinuation should be considered. (Level of Evidence: C) "

"3. Clopidogrel 75 mg daily[10][11] (Level of Evidence: A), prasugrel*** 10 mg daily (in PCI-treated patients)[12] (Level of Evidence: C), or ticagrelor 90 mg twice daily[6] (Level of Evidence: C) should be given to patients recovering from UA/NSTEMI when aspirin is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as PPIs).[13][14]"
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 IIa
"1. After PCI, it is reasonable to use 81 mg per day of aspirin in preference to higher maintenance doses. (Level of Evidence: B)"
Class IIb
"1. For UA/NSTEMI patients who have an indication for anticoagulation, the addition of warfarin§ may be reasonable to maintain an INR of 2.0 to 3.0.∥ (Level of Evidence: B)"
"2. Continuation of a P2Y12 receptor inhibitor beyond 12 months may be considered in patients following DES placement. (Level of Evidence: C)"

* For aspirin-allergic patients, use either clopidogrel or ticagrelor alone (indefinitely) or try aspirin desensitization. Note that there are no data for therapy with 2 concurrent P2Y12 receptor inhibitors, and this is not recommended in the case of aspirin allergy.

** The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily. Ticagrelor's benefits were observed irrespective of prior therapy with clopidogrel. When possible, discontinue ticagrelor at least 5 d before any surgery. Issues of patient compliance may be especially important. Consideration should be given to the potential and as yet undetermined risk of intracranial hemorrhage in patients with prior stroke or TIA.

*** Patients weighing <60 kg have an increased exposure to the active metabolite of prasugrel and an increased risk of bleeding on a 10-mg once-daily maintenance dose. Consideration should be given to lowering the maintenance dose to 5 mg in patients who weigh <60 kg, although the effectiveness and safety of the 5-mg dose have not been studied prospectively. For post-PCI patients, a daily maintenance dose should be given for at least 12 mo for patients receiving DES and up to 12 mo for patients receiving BMS unless the risk of bleeding outweighs the anticipated net benefit afforded by a P2Y12 receptor inhibitor. Do not use prasugrel in patients with active pathological bleeding or a history of TIA or stroke. In patients age ≥75 y, prasugrel is generally not recommended because of the increased risk of fatal and intracranial bleeding and uncertain benefit except in high-risk situations (patients with diabetes or a history of prior myocardial infarction), in which its effect appears to be greater and its use may be considered. Do not start prasugrel in patients likely to undergo urgent CABG. When possible, discontinue prasugrel at least 7 d before any surgery. Additional risk factors for bleeding include body weight <60 kg, propensity to bleed, and concomitant use of medications that increase the risk of bleeding (eg, warfarin, heparin, fibrinolytic therapy, or chronic use of nonsteroidal anti-inflammatory drugs).

§ Continue aspirin 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 aspirin and a P2Y12 receptor inhibitor, 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).

Related Chapters

References

  1. ↑ 1.0 1.1 2012 Writing Committee Members. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR; et al. (2012). "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". Circulation. 126 (7): 875–910. doi:10.1161/CIR.0b013e318256f1e0. PMID 22800849.
  2. ↑ Antithrombotic Trialists' (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J; et al. (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. Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-4, JC3-5 Review in: Evid Based Med. 2009 Dec;14(6):172-3
  3. ↑ Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA; et al. (1985). "Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial". N Engl J Med. 313 (22): 1369–75. doi:10.1056/NEJM198511283132201. PMID 3903504.
  4. ↑ Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE; et al. (1983). "Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study". N Engl J Med. 309 (7): 396–403. doi:10.1056/NEJM198308183090703. PMID 6135989.
  5. ↑ Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH (1997). "Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men". N Engl J Med. 336 (14): 973–9. doi:10.1056/NEJM199704033361401. PMID 9077376.
  6. ↑ 6.0 6.1 6.2 6.3 Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C; et al. (2009). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4
  7. ↑ James SK, Roe MT, Cannon CP, Cornel JH, Horrow J, Husted S; et al. (2011). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial". BMJ. 342: d3527. doi:10.1136/bmj.d3527. PMC 3117310. PMID 21685437.
  8. ↑ 8.0 8.1 Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK; et al. (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.
  9. ↑ Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S; et al. (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182.
  10. ↑ 10.0 10.1 Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK; et al. (2001). "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation". N Engl J Med. 345 (7): 494–502. doi:10.1056/NEJMoa010746. PMID 11519503. Review in: ACP J Club. 2002 Mar-Apr;136(2):45
  11. ↑ CAPRIE Steering Committee (1996). "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee". Lancet. 348 (9038): 1329–39. PMID 8918275.
  12. ↑ Sosnowski C (2008). "[Commentary to the article: Wiviott S D, Braunwald E, McCabe C H et al. Prasugrel versus clopidogrel in patients with acute coronary syndrome. N Engl J Med 2007; 357: 2001-15]". Kardiol Pol. 66 (2): 222–5, discussion 225-6. PMID 18634190.
  13. ↑ Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ; et al. (2010). "Clopidogrel with or without omeprazole in coronary artery disease". N Engl J Med. 363 (20): 1909–17. doi:10.1056/NEJMoa1007964. PMID 20925534. Review in: Evid Based Med. 2011 Oct;16(5):144-5 Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-7
  14. ↑ Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA (2004). "Aspirin sensitivity: implications for patients with coronary artery disease". JAMA. 292 (24): 3017–23. doi:10.1001/jama.292.24.3017. PMID 15613671.

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