Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention: Difference between revisions
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==Overview of Long-Term Medical Therapy and Secondary Prevention for UA / NSTEMI== | ==Overview of Long-Term Medical Therapy and Secondary Prevention for UA / NSTEMI== | ||
==ACC / AHA Guidelines- Antiplatelet Therapy (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>== | |||
{{cquote| | |||
===Class I=== | |||
1. For [[UA]]/[[NSTEMI]] patients treated medically without [[stent]]ing, [[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 ''(Level of Evidence: A)'' and ideally for up to 1 year. ''(Level of Evidence: B)'' | |||
2. For [[UA]]/[[NSTEMI]] patients treated with [[bare-metal stent]]s, [[aspirin]] 162 to 325 mg per day should be prescribed for at least 1 month ''(Level of Evidence: B)'', then continued indefinitely at a dose of 75 to 162 mg per day ''(Level of Evidence: A)''; [[clopidogrel]] should be prescribed at a dose of 75 mg per day for a minimum of 1 month and ideally for up to 1 year (unless the patient is at increased risk of bleeding, then it should be given for a minimum of 2 weeks). ''(Level of Evidence: B)'' | |||
3. For [[UA]]/[[NSTEMI]] patients treated with [[DES]], [[aspirin]] 162 to 325 mg per day should be prescribed for at least 3 months after [[sirolimus-eluting stent]] implantation and 6 months after [[paclitaxel-eluting stent]] implantation then continued indefinitely at a dose of 75 to 162 mg per day. ''(Level of Evidence: B)'' [[Clopidogrel]] 75 mg daily should be given for at least 12 months to all post-[[PCI]] patients receiving [[DES]]. ''(Level of Evidence: B)'' | |||
4. [[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 gastrointestinal intolerance (but with gastroprotective agents such as [[proton-pump inhibitor]]s). ''(Level of Evidence: A)'' | |||
===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]], add [[warfarin]] to maintain an international normalization ratio of 2.0 to 3.0. ''(Level of Evidence: B)'' | |||
===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: A)''}} | |||
==ACC / AHA Guidelines- Beta Blockers (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>== | ==ACC / AHA Guidelines- Beta Blockers (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>== | ||
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===Class I=== | ===Class I=== | ||
1. [[Beta blocker]]s are indicated for all patients recovering from [[UA]] / [[NSTEMI]] unless contraindicated. Treatment should begin within a few days of the event, if not initiated acutely, and should be continued indefinitely. (Level of Evidence: B) | 1. [[Beta blocker]]s are indicated for all patients recovering from [[UA]] / [[NSTEMI]] unless contraindicated. Treatment should begin within a few days of the event, if not initiated acutely, and should be continued indefinitely. ''(Level of Evidence: B)'' | ||
2. Patients recovering from [[UA]] / [[NSTEMI]] with moderate or severe [[LV failure]] should receive [[beta blocker]] therapy with a gradual titration scheme. (Level of Evidence: B) | 2. Patients recovering from [[UA]] / [[NSTEMI]] with moderate or severe [[LV failure]] should receive [[beta blocker]] therapy with a gradual titration scheme. ''(Level of Evidence: B)'' | ||
===Class IIa=== | ===Class IIa=== | ||
1. It is reasonable to prescribe [[beta blocker]]s to low-risk patients (i.e., normal LV function, revascularized, no high risk features) recovering from [[UA]] / [[NSTEMI]] in the absence of absolute contraindications. (Level of Evidence: B)}} | 1. It is reasonable to prescribe [[beta blocker]]s to low-risk patients (i.e., normal LV function, revascularized, no high risk features) recovering from [[UA]] / [[NSTEMI]] in the absence of absolute contraindications. ''(Level of Evidence: B)''}} | ||
==See Also== | ==See Also== | ||
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Overview of Long-Term Medical Therapy and Secondary Prevention for UA / NSTEMI
ACC / AHA Guidelines- Antiplatelet Therapy (DO NOT EDIT) [1]
| “ |
Class I1. 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 (Level of Evidence: A) and ideally for up to 1 year. (Level of Evidence: B) 2. For UA/NSTEMI patients treated with bare-metal stents, aspirin 162 to 325 mg per day should be prescribed for at least 1 month (Level of Evidence: B), then continued indefinitely at a dose of 75 to 162 mg per day (Level of Evidence: A); clopidogrel should be prescribed at a dose of 75 mg per day for a minimum of 1 month and ideally for up to 1 year (unless the patient is at increased risk of bleeding, then it should be given for a minimum of 2 weeks). (Level of Evidence: B) 3. For UA/NSTEMI patients treated with DES, aspirin 162 to 325 mg per day should be prescribed for at least 3 months after sirolimus-eluting stent implantation and 6 months after paclitaxel-eluting stent implantation then continued indefinitely at a dose of 75 to 162 mg per day. (Level of Evidence: B) Clopidogrel 75 mg daily should be given for at least 12 months to all post-PCI patients receiving DES. (Level of Evidence: B) 4. 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 gastrointestinal intolerance (but with gastroprotective agents such as proton-pump inhibitors). (Level of Evidence: A) 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, add warfarin to maintain an international normalization ratio of 2.0 to 3.0. (Level of Evidence: B) Class III1. 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: A) |
” |
ACC / AHA Guidelines- Beta Blockers (DO NOT EDIT) [1]
| “ |
Class I1. Beta blockers are indicated for all patients recovering from UA / NSTEMI unless contraindicated. Treatment should begin within a few days of the event, if not initiated acutely, and should be continued indefinitely. (Level of Evidence: B) 2. Patients recovering from UA / NSTEMI with moderate or severe LV failure should receive beta blocker therapy with a gradual titration scheme. (Level of Evidence: B) Class IIa1. It is reasonable to prescribe beta blockers to low-risk patients (i.e., normal LV function, revascularized, no high risk features) recovering from UA / NSTEMI in the absence of absolute contraindications. (Level of Evidence: B) |
” |
See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 1.2 Anderson JL, Adams CD, Antman EM; et al. (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". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
|month=ignored (help)