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__NOTOC__
{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD
 
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


==Overview==
==Overview==
In patients with [[ischemic heart disease]], prophylactic low dose aspirin prevents arterial thrombosis by irreversible inactivation of platelet aggregation.<ref name="pmid8298418"> (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8298418 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.] ''BMJ'' 308 (6921):81-106. PMID: [http://pubmed.gov/8298418 8298418]</ref> <ref name="pmid14720534">Patrono C, Bachmann F, Baigent C, Bode C, De Caterina R, Charbonnier B et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14720534 Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology.] ''Eur Heart J'' 25 (2):166-81. PMID: [http://pubmed.gov/14720534 14720534]</ref> <ref name="pmid15383474">Patrono C, Coller B, FitzGerald GA, Hirsh J, Roth G (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15383474 Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.] ''Chest'' 126 (3 Suppl):234S-264S. [http://dx.doi.org/10.1378/chest.126.3_suppl.234S DOI:10.1378/chest.126.3_suppl.234S] PMID: [http://pubmed.gov/15383474 15383474]</ref> <ref name="pmid11786451">Antithrombotic Trialists' Collaboration (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11786451 Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.] ''BMJ'' 324 (7329):71-86. PMID: [http://pubmed.gov/11786451 11786451]</ref>
==Mechanisms of benefit==
*Aspirin is a potent anti-platelet agent.
*[[Aspirin]] induces an irreversible functional defect in platelets by inhibiting cyclo oxygenase (COX-1) and subsequently suppressing the activation of [[thromboxane A2]] that is responsible for platelet aggregation.<ref name="pmid8145785">Patrono C (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8145785 Aspirin as an antiplatelet drug.] ''N Engl J Med'' 330 (18):1287-94. [http://dx.doi.org/10.1056/NEJM199405053301808 DOI:10.1056/NEJM199405053301808] PMID: [http://pubmed.gov/8145785 8145785]</ref>
*In patients with chronic stable angina, prior [[MI]] and [[unstable angina]], aspirin improves survival and prevents infarction.<ref name="pmid11786451">Antithrombotic Trialists' Collaboration (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11786451 Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.] ''BMJ'' 324 (7329):71-86. PMID: [http://pubmed.gov/11786451 11786451]</ref>
*Aspirin has shown to improve endothelial function and at high doses reduce acute phase reactants.
==Indication==
All patients with chronic stable angina, aspirin unless contraindicated should be started at 75 to 162 mg/day and continued indefinitely.<ref name="pmid15383474">Patrono C, Coller B, FitzGerald GA, Hirsh J, Roth G (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15383474 Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.] ''Chest'' 126 (3 Suppl):234S-264S. [http://dx.doi.org/10.1378/chest.126.3_suppl.234S DOI:10.1378/chest.126.3_suppl.234S] PMID: [http://pubmed.gov/15383474 15383474]</ref>
==Contra-indications==
*Gastrointestinal bleed
*Aspirin hypersensitivity (triad of rhinitis, asthma and polyposis)
*Coagulation disorder
*Uncontrolled hypertension <ref name="pmid9635947">Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9635947 Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group.] ''Lancet'' 351 (9118):1755-62. PMID: [http://pubmed.gov/9635947 9635947]</ref>


'''Mechanism of benefit:'''
==Dosage==
*[[Aspirin]] inhibits cyclo oxygenase and the subsequent suppression of [[thromboxane A2]], the key moderator of irreversible platelet aggregation.
*A dose range of '''75 to 162 mg/day''' of aspirin <ref name="pmid11786451">Antithrombotic Trialists' Collaboration (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11786451 Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.] ''BMJ'' 324 (7329):71-86. PMID: [http://pubmed.gov/11786451 11786451]</ref> appears to be effective and is associated with lower risk of gastrointestinal bleeding.  
*Aspirin is a potent anti platelet agent and has been shown to improve survival and to prevent infarction in patients with [[unstable angina]] or after [[myocardial infarction]].  


'''Aspirin dosing:'''
*In comparison to a dose range of 160-325 mg/day, a lower dose of aspirin (75-162mg/d) has a higher efficacy for secondary prevention.
*A 75-mg dose has been shown to be effective and causes less gastrointestinal bleeding than the commonly prescribed 325 mg dose.
:*Aspirin also improves endothelial function and, when used in high dose (300 mg/day), has been shown to reduce circulating levels of [[C-reactive protein]]. Therefore, it should be started at 75 to 162 mg/day and continued indefinitely in all patients with chronic stable angina pectoris, unless contraindicated.
:*75 to 162 mg/day aspirin dosing range appears to have comparable efficacy for secondary prevention compared to dosing at 160-325 mg/day and also reduces bleeding risk.


*Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely.
*Aspirin improves endothelial function and at higher doses (300 mg/day) reduce the circulating levels of [[C-reactive protein]]. <ref name="pmid9077376">Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9077376 Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.] ''N Engl J Med'' 336 (14):973-9. [http://dx.doi.org/10.1056/NEJM199704033361401 DOI:10.1056/NEJM199704033361401] PMID: [http://pubmed.gov/9077376 9077376]</ref>


'''Supportive trial data:'''
==Drug interactions==
*'''Meta-analysis''' of 140,000 patients from the Antiplatelet Trialists’ Collaboration showed that aspirin (75-325 mg/day) reduced the rate of subsequent [[myocardial infarction]], [[stroke]], and death in patients with history of [[angina]] pectoris, myocardial infarction, [[CABG]], and stroke.  
Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and hence close monitoring is required.


*In the Swedish Angina Pectoris Aspirin Trial ('''SAPAT'''), aspirin (75 mg/day) in conjunction with the [[beta blocker]] sotalol conferred an additional 34% reduction in acute [[myocardial infarction]] and [[sudden cardiac death]] among men and women with chronic stable angina.
==Adverse effects==
A higher dose of aspirin is associated with increased risk of gastrointestinal bleed.<ref name="pmid15383474">Patrono C, Coller B, FitzGerald GA, Hirsh J, Roth G (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15383474 Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.] ''Chest'' 126 (3 Suppl):234S-264S. [http://dx.doi.org/10.1378/chest.126.3_suppl.234S DOI:10.1378/chest.126.3_suppl.234S] PMID: [http://pubmed.gov/15383474 15383474]</ref>
 
==Supportive trial data==
*Meta-analysis of 140,000 patients from the '''Antiplatelet Trialists’ Collaboration''' showed that aspirin (75-325 mg/day) reduced the rate of subsequent [[myocardial infarction]], [[stroke]], and death in patients with history of [[angina pectoris]], myocardial infarction, [[CABG]], and stroke.
 
*In the Swedish Angina Pectoris Aspirin Trial ('''SAPAT'''), aspirin (75 mg/day) in conjunction with the [[beta blocker]] sotalol conferred an additional 34% reduction in [[MI| acute myocardial infarction]] and [[sudden cardiac death]] among men and women with chronic stable angina.
 
*'''Meta-analysis''' of 24 randomized controlled trials involving 66,000 patients showed significant increase in the incidence of gastrointestinal hemorrhage associated with long term aspirin therapy. There was no supportive evidence of lower dose or modified release formulations reducing the incidence of GI bleed.<ref name="pmid11073508">Derry S, Loke YK (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11073508 Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis.] ''BMJ'' 321 (7270):1183-7. PMID: [http://pubmed.gov/11073508 11073508]</ref>


==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>==
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>==
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===Class IIa===
===Class IIa===
'''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''}}
'''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''}}
==ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367}}</ref>==
{{cquote|
===Class I===
'''1.''' Aspirin 75 mg daily in all patients without specific contraindications (i.e. active GI bleeding, aspirin allergy,
or previous aspirin intolerance). ''(Level of Evidence: A)''}}


==Vote on and Suggest Revisions to the Current Guidelines==
==Vote on and Suggest Revisions to the Current Guidelines==
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==Sources==
==Sources==
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>


*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
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{{Reflist|2}}
{{Reflist|2}}


[[Category: Disease state]]  
[[Category:Ischemic heart diseases]]
[[Category: Ischemic heart diseases]]
 
[[Category: Cardiology]]
[[Category:Disease state]]
[[Category: Emergency medicine]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]


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Revision as of 20:44, 18 August 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [5]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

In patients with ischemic heart disease, prophylactic low dose aspirin prevents arterial thrombosis by irreversible inactivation of platelet aggregation.[1] [2] [3] [4]

Mechanisms of benefit

  • Aspirin is a potent anti-platelet agent.
  • Aspirin induces an irreversible functional defect in platelets by inhibiting cyclo oxygenase (COX-1) and subsequently suppressing the activation of thromboxane A2 that is responsible for platelet aggregation.[5]
  • In patients with chronic stable angina, prior MI and unstable angina, aspirin improves survival and prevents infarction.[4]
  • Aspirin has shown to improve endothelial function and at high doses reduce acute phase reactants.

Indication

All patients with chronic stable angina, aspirin unless contraindicated should be started at 75 to 162 mg/day and continued indefinitely.[3]

Contra-indications

  • Gastrointestinal bleed
  • Aspirin hypersensitivity (triad of rhinitis, asthma and polyposis)
  • Coagulation disorder
  • Uncontrolled hypertension [6]

Dosage

  • A dose range of 75 to 162 mg/day of aspirin [4] appears to be effective and is associated with lower risk of gastrointestinal bleeding.
  • In comparison to a dose range of 160-325 mg/day, a lower dose of aspirin (75-162mg/d) has a higher efficacy for secondary prevention.
  • Aspirin improves endothelial function and at higher doses (300 mg/day) reduce the circulating levels of C-reactive protein. [7]

Drug interactions

Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and hence close monitoring is required.

Adverse effects

A higher dose of aspirin is associated with increased risk of gastrointestinal bleed.[3]

Supportive trial data

  • Meta-analysis of 140,000 patients from the Antiplatelet Trialists’ Collaboration showed that aspirin (75-325 mg/day) reduced the rate of subsequent myocardial infarction, stroke, and death in patients with history of angina pectoris, myocardial infarction, CABG, and stroke.
  • Meta-analysis of 24 randomized controlled trials involving 66,000 patients showed significant increase in the incidence of gastrointestinal hemorrhage associated with long term aspirin therapy. There was no supportive evidence of lower dose or modified release formulations reducing the incidence of GI bleed.[8]

ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)[9][10][11]

“

Class I

1. Aspirin should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. (Level of Evidence: A)

2. Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely. (Level of Evidence: B)

Class IIa

1. Clopidogrel when aspirin is absolutely contraindicated. (Level of Evidence: B)

”

ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT)[12]

“

Class I

1. Aspirin 75 mg daily in all patients without specific contraindications (i.e. active GI bleeding, aspirin allergy, or previous aspirin intolerance). (Level of Evidence: A)

”

Vote on and Suggest Revisions to the Current Guidelines

Sources

  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [12]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [9]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [10]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [11]

References

  1. ↑ (1994) 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. BMJ 308 (6921):81-106. PMID: 8298418
  2. ↑ Patrono C, Bachmann F, Baigent C, Bode C, De Caterina R, Charbonnier B et al. (2004) Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J 25 (2):166-81. PMID: 14720534
  3. ↑ 3.0 3.1 3.2 Patrono C, Coller B, FitzGerald GA, Hirsh J, Roth G (2004) Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126 (3 Suppl):234S-264S. DOI:10.1378/chest.126.3_suppl.234S PMID: 15383474
  4. ↑ 4.0 4.1 4.2 Antithrombotic Trialists' Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324 (7329):71-86. PMID: 11786451
  5. ↑ Patrono C (1994) Aspirin as an antiplatelet drug. N Engl J Med 330 (18):1287-94. DOI:10.1056/NEJM199405053301808 PMID: 8145785
  6. ↑ Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S et al. (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351 (9118):1755-62. PMID: 9635947
  7. ↑ 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
  8. ↑ Derry S, Loke YK (2000) Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 321 (7270):1183-7. PMID: 11073508
  9. ↑ 9.0 9.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
  10. ↑ 10.0 10.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
  11. ↑ 11.0 11.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462
  12. ↑ 12.0 12.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.


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