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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Esther Lee (talk | contribs) (/* ACC / AHA Guidelines for Convalescent and Long-Term Antiplatelet Therapy{{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...) |
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For [[UA/NSTEMI]] patients treated medically without [[stent]]ing, aspirin | | 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> | ||
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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: | ||
*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, [[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]]) | ||
*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> |
Revision as of 18:13, 11 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 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:
|
"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
References
- ↑ 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.