Antiplatelet therapy to support PCI: Difference between revisions

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| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: ‌B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref><ref name="pmid11786451">{{cite journal| author=Antithrombotic Trialists' Collaboration| title=Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. | journal=BMJ | year= 2002 | volume= 324 | issue= 7329 | pages= 71-86 | pmid=11786451 | doi=10.1136/bmj.324.7329.71 | pmc=64503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11786451  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12093204 Review in: ACP J Club. 2002 Jul-Aug;137(1):5] </ref><ref name="pmid8298418">{{cite journal| author=| title=Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. | journal=BMJ | year= 1994 | volume= 308 | issue= 6921 | pages= 81-106 | pmid=8298418 | doi= | pmc=2539220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8298418  }} </ref><ref name="pmid19482214">{{cite journal| author=Antithrombotic Trialists' (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J | display-authors=etal| 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=2715005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19482214  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19755350 Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-4, JC3-5]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19949174 Review in: Evid Based Med. 2009 Dec;14(6):172-3] </ref><ref name="pmid16143698">{{cite journal| author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P | display-authors=etal| title=Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. | journal=JAMA | year= 2005 | volume= 294 | issue= 10 | pages= 1224-32 | pmid=16143698 | doi=10.1001/jama.294.10.1224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16143698  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16539344 Review in: ACP J Club. 2006 Mar-Apr;144(2):29] </ref><ref name="pmid17982182">{{cite journal| author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S | display-authors=etal| 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=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17982182  }} </ref><ref name="pmid25175921">{{cite journal| author=Montalescot G, van 't Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L | display-authors=etal| title=Prehospital ticagrelor in ST-segment elevation myocardial infarction. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1016-27 | pmid=25175921 | doi=10.1056/NEJMoa1407024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25175921  }} </ref><ref name="pmid11479250">{{cite journal| author=Taniuchi M, Kurz HI, Lasala JM| title=Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population. | journal=Circulation | year= 2001 | volume= 104 | issue= 5 | pages= 539-43 | pmid=11479250 | doi=10.1161/hc3001.093435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479250  }} </ref><ref name="pmid23287889">{{cite journal| author=Bellemain-Appaix A, O'Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O | display-authors=etal| title=Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. | journal=JAMA | year= 2012 | volume= 308 | issue= 23 | pages= 2507-16 | pmid=23287889 | doi=10.1001/jama.2012.50788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23287889  }} </ref><ref name="pmid8598866">{{cite journal| author=Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M | display-authors=etal| title=A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 17 | pages= 1084-9 | pmid=8598866 | doi=10.1056/NEJM199604253341702 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8598866  }} </ref><ref name="pmid10318654">{{cite journal| author=Moussa I, Oetgen M, Roubin G, Colombo A, Wang X, Iyer S | display-authors=etal| title=Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. | journal=Circulation | year= 1999 | volume= 99 | issue= 18 | pages= 2364-6 | pmid=10318654 | doi=10.1161/01.cir.99.18.2364 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10318654  }} </ref><ref name="pmid10966552">{{cite journal| author=Calver AL, Blows LJ, Harmer S, Dawkins KD, Gray HH, Morgan JH | display-authors=etal| title=Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents. | journal=Am Heart J | year= 2000 | volume= 140 | issue= 3 | pages= 483-91 | pmid=10966552 | doi=10.1067/mhj.2000.108825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10966552  }} </ref>
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: ‌B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref><ref name="pmid11786451">{{cite journal| author=Antithrombotic Trialists' Collaboration| title=Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. | journal=BMJ | year= 2002 | volume= 324 | issue= 7329 | pages= 71-86 | pmid=11786451 | doi=10.1136/bmj.324.7329.71 | pmc=64503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11786451  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12093204 Review in: ACP J Club. 2002 Jul-Aug;137(1):5] </ref><ref name="pmid8298418">{{cite journal| author=| title=Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. | journal=BMJ | year= 1994 | volume= 308 | issue= 6921 | pages= 81-106 | pmid=8298418 | doi= | pmc=2539220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8298418  }} </ref><ref name="pmid19482214">{{cite journal| author=Antithrombotic Trialists' (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J | display-authors=etal| 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=2715005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19482214  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19755350 Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-4, JC3-5]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19949174 Review in: Evid Based Med. 2009 Dec;14(6):172-3] </ref><ref name="pmid16143698">{{cite journal| author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P | display-authors=etal| title=Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. | journal=JAMA | year= 2005 | volume= 294 | issue= 10 | pages= 1224-32 | pmid=16143698 | doi=10.1001/jama.294.10.1224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16143698  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16539344 Review in: ACP J Club. 2006 Mar-Apr;144(2):29] </ref><ref name="pmid17982182">{{cite journal| author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S | display-authors=etal| 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=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17982182  }} </ref><ref name="pmid25175921">{{cite journal| author=Montalescot G, van 't Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L | display-authors=etal| title=Prehospital ticagrelor in ST-segment elevation myocardial infarction. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1016-27 | pmid=25175921 | doi=10.1056/NEJMoa1407024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25175921  }} </ref><ref name="pmid11479250">{{cite journal| author=Taniuchi M, Kurz HI, Lasala JM| title=Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population. | journal=Circulation | year= 2001 | volume= 104 | issue= 5 | pages= 539-43 | pmid=11479250 | doi=10.1161/hc3001.093435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479250  }} </ref><ref name="pmid23287889">{{cite journal| author=Bellemain-Appaix A, O'Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O | display-authors=etal| title=Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. | journal=JAMA | year= 2012 | volume= 308 | issue= 23 | pages= 2507-16 | pmid=23287889 | doi=10.1001/jama.2012.50788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23287889  }} </ref><ref name="pmid8598866">{{cite journal| author=Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M | display-authors=etal| title=A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 17 | pages= 1084-9 | pmid=8598866 | doi=10.1056/NEJM199604253341702 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8598866  }} </ref><ref name="pmid10318654">{{cite journal| author=Moussa I, Oetgen M, Roubin G, Colombo A, Wang X, Iyer S | display-authors=etal| title=Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. | journal=Circulation | year= 1999 | volume= 99 | issue= 18 | pages= 2364-6 | pmid=10318654 | doi=10.1161/01.cir.99.18.2364 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10318654  }} </ref><ref name="pmid10966552">{{cite journal| author=Calver AL, Blows LJ, Harmer S, Dawkins KD, Gray HH, Morgan JH | display-authors=etal| title=Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents. | journal=Am Heart J | year= 2000 | volume= 140 | issue= 3 | pages= 483-91 | pmid=10966552 | doi=10.1067/mhj.2000.108825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10966552 }} </ref><ref name="pmid19717846">{{cite journal| author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C | display-authors=etal| 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=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717846  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=20008753 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4] </ref><ref name="pmid10673248">{{cite journal| author=Müller C, Büttner HJ, Petersen J, Roskamm H| title=A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents. | journal=Circulation | year= 2000 | volume= 101 | issue= 6 | pages= 590-3 | pmid=10673248 | doi=10.1161/01.cir.101.6.590 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10673248 }} </ref>
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| bgcolor="LightGreen"|1. A loading [[dose]] of [[aspirin]], followed by daily [[dose|dosing]] is recommended to reduce [[ischemima|ischemic events]] in [[patients]] who are undergoing [[PCI]].
| bgcolor="LightGreen"|1. A loading [[dose]] of [[aspirin]], followed by daily [[dose|dosing]] is recommended to reduce [[ischemima|ischemic events]] in [[patients]] who are undergoing [[PCI]].

Revision as of 15:20, 10 July 2022

Percutaneous coronary intervention Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2] Anahita Deylamsalehi, M.D.[3]

Overview

2011 AHA guidelines recommend the use of antiplatelet therapy with aspirin (Level of Evidence: B) and P2Y12 receptor inhibitor (clopidogrel, prasugrel and ticagrelor) (Level of Evidence: A) to support percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Few randomised trials have been conducted showing comparison of clopidogrel with aspirin and other P2Y12 inhibitors (prasugrel and ticagrelor) in terms of clinical benefit and risk of bleeding when given in patients undergoing PCI. However, there is limited data comparing new P2Y12 receptor inhibitors (prasugrel and ticagrelor) for downstream and upstream therapy in patients undergoing PCI with non ST elevation MI in terms of clinical benefit and adverse effects. Hence, a new large scale randomised open label trial called DUBIUS is in process in Italy comparing two new P2Y12 inhibitors prasugrel and ticagrelor for pretreatment in patients with non ST elevation MI undergoing PCI.

Antiplatelet Therapy to Support PCI

2011 AHA guidelines recommend the use of antiplatelet therapy aspirin (Level of Evidence: B) and P2Y12 receptor inhibitor (clopidogrel, prasugrel and ticagrelor) (Level of Evidence: A) to support PCI in patients with ACS. Few randomised trials have been conducted showing comparison of clopidogrel with aspirin and other P2Y12 inhibitors (prasugrel and ticagrelor) in terms of clinical benefit and risk of bleeding when given in patients undergoing PCI.[1][2][3][4][5] However, there is limited data comparing new P2Y12 receptor inhibitors (prasugrel and ticagrelor) for downstream and upstream therapy in patients undergoing PCI with non ST elevation MI in terms of clinical benefit and adverse effects. Hence, a new large scale randomised open label trial called DUBIUS is in process in Italy comparing two new P2Y12 inhibitors prasugrel and ticagrelor for pretreatment in patients with non ST elevation MI undergoing PCI. It is a trial designed for superiority comparing downstream therapy over upstream therapy in terms of NACE (net adverse cardaic effect) and risk of major bleeding (BARC 3, 4 and 5). Another endpoint considered in the trial is non inferiority comparison between prasugrel and ticagrelor in terms of potency of the drug for clinical benefit and NACE.

2021 ACA Revascularization Guideline

Class 1 Recommendation, Level of Evidence: ‌B-R[6][7][8][9][2][4][10][11][12][13][14][15][5][16]
1. A loading dose of aspirin, followed by daily dosing is recommended to reduce ischemic events in patients who are undergoing PCI.

2. A loading dose of P2Y12 inhibitor, followed by daily dosing is recommended to reduce ischemic events in patients with ACS who are undergoing PCI.

Class 1 Recommendation, Level of Evidence: C-LD [6]
1. A loading dose of clopidogrel, followed by daily dosing is recommended to reduce ischemic events in patients with stable ischemic heart disease (SIHD) who are undergoing PCI.

2. A loading dose of 300 mg of clopidogrel, followed by daily dosing is recommended to reduce ischemic events in patients undergoing PCI within 24 hours after fibrinolytic therapy.

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[17]

Oral Antiplatelet Therapy (DO NOT EDIT)[17]

Class I
"1. Patients already taking daily aspirin therapy should take 81 mg to 325 mg before PCI.[18][19][20] (Level of Evidence: B)"
"2. Patients not on aspirin therapy should be given non-enteric aspirin 325 mg before PCI.[18][20] (Level of Evidence: B)"
"3. After PCI, use of aspirin should be continued indefinitely.[13][7][9][21] (Level of Evidence: A)"
"4. A loading dose of a P2Y12 receptor inhibitor should be given to patients undergoing PCI with stenting.[1][2][3][4][5] (Level of Evidence: A) Options include:
a. Clopidogrel 600 mg (ACS and non-ACS patients).[1][1][2][3][4][5][2][3](Level of Evidence: B)
b. Prasugrel 60 mg (ACS patients).[1][2][3][4][5][4] (Level of Evidence: B)
c. Ticagrelor 180 mg (ACS patients).[5] (Level of Evidence: B)"
"5. The loading dose of clopidogrel for patients undergoing PCI after fibrinolytic therapy should be 300 mg within 24 hours and 600 mg more than 24 hours after receiving fibrinolytic therapy.[2][22] (Level of Evidence: C)"
"6. Patients should be counseled on the need for and risks of dual antiplatelet therapy (DAPT) before placement of intra-coronary stents, especially drug eluting stents (DES), and alternative therapies should be pursued if patients are unwilling or unable to comply with the recommended duration of dual antiplatelet therapy.[23] (Level of Evidence: C)"
"7. The duration of P2Y12 receptor inhibitor therapy after stent implantation should generally be as follows:
a. In patients receiving a stent (bare metal stent (BMS) or drug eluting stent (DES)) during PCI for ACS, P2Y12 receptor inhibitor therapy should be given for at least 12 months. Options include clopidogrel 75 mg daily [24],prasugrel 10 mg daily [4], and ticagrelor 90 mg twice daily.[5] (Level of Evidence: B)
b. In patients receiving drug eluting stent (DES) for a non-ACS indication, clopidogrel 75 mg daily should be given for at least 12 months if patients are not at high risk of bleeding.[23][25][26] (Level of Evidence: B)
c. In patients receiving bare metal stent (BMS) for a non-ACS indication, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).[23][27] (Level of Evidence: B)"
Class III (Harm)
"1. Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack.[4] (Level of Evidence: B)"
Class IIa
"1. After PCI, it is reasonable to use aspirin 81 mg per day in preference to higher maintenance doses.[19][28][29][30][31] (Level of Evidence: B)"
"2. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of P2Y12 receptor inhibitor therapy after stent implantation, earlier discontinuation (e.g.,less than 12 months) of P2Y12 receptor inhibitor therapy is reasonable. (Level of Evidence: C)"
Class IIb
"1. Continuation of dual antiplatelet therapy (DAPT) beyond 12 months may be considered in patients undergoing drug eluting stent (DES) implantation.[4][5] (Level of Evidence: C)"

Dual Antiplatelet Therapy Compliance and Stent Thrombosis (DO NOT EDIT) [17]

Class III (Harm)

"1. PCI with coronary stenting (BMS or DES) should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy (DAPT) for the appropriate duration of treatment based on the type of stent implanted. [23][32][33][34](Level of Evidence: B)"

References

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