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

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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): Convalescent and Long-Term Antiplatelet Therapy (DO NOT EDIT)

Class I

"1. For UA/NSTEMI patients treated medically without stenting, aspirin should be prescribed indefinitely (Level of Evidence: A); clopidogrel (75 mg per day) or ticagrelor (90 mg twice daily) should be prescribed for up to 12 months. (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, 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. (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 (Level of Evidence: A), prasugrel 10 mg daily (in PCI-treated patients) (Level of Evidence: C), or ticagrelor 90 mg twice daily ((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). "

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, add warfarin to maintain an international normalization ratio 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) "

Related Chapters

• The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines