Pharmacotherapy to Support PCI: Difference between revisions
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===[[Antiplatelet therapy to support PCI|Antiplatelet Therapy to Support PCI]]=== | ===[[Antiplatelet therapy to support PCI|Antiplatelet Therapy to Support PCI]]=== | ||
==2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease<ref name="pmid27751237">{{cite journal| author=Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA et al.| title=2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 5 | pages= 1243-1275 | pmid=27751237 | doi=10.1016/j.jtcvs.2016.07.044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27751237 }} </ref>== | |||
==Recommendations for Duration of DAPT in Patients With ACS Treated With PCI== | |||
{|class="wikitable"style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''In patients with ACS treated with DAPT after BMS or DES implantation, P2Y12 inhibitor therapy (clopidogrel, | |||
prasugrel, or ticagrelor) should be given for at least 12 months''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''In patients treated with DAPT, a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is recommended''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''In patients with ACS treated with DAPT after coronary stent implantation, it is reasonable to use ticagrelor in preference to clopidogrel for maintenance P2Y12 inhibitor therapy''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''In patients with ACS treated with DAPT after coronary stent implantation, who are not at high risk for bleeding complications and who do not have a history of stroke or TIA, it is reasonable to choose prasugrel over clopidogrel for maintenance P2Y12 inhibitor therapy (''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''In patients with ACS treated with coronary stent implantation who have tolerated DAPT without bleeding complication and who are not at high bleeding risk (e.g., prior bleeding on DAPT, coagulopathy, oral anticoagulant use) continuation of DAPT for longer than 12 months may be reasonable''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A SR]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''In patients with ACS treated with DAPT after DES implantation who develop a high risk of bleeding (e.g., treatment with oral anticoagulant therapy), are at high risk of severe bleeding complication (e.g., major intracranial surgery), or develop significant overt bleeding, discontinuation of P2Y12 therapy after 6 months may be reasonable''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable"style="width:80%" | |||
|- | |||
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |||
|- | |||
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''Prasugrel should not be administered to patients with a prior history of stroke or TIA''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' | |||
<nowiki>"</nowiki> | |||
|} | |||
===[[Antithrombin therapy to support PCI|Antithrombin Therapy to Support PCI]]=== | ===[[Antithrombin therapy to support PCI|Antithrombin Therapy to Support PCI]]=== | ||
Revision as of 18:06, 1 November 2016
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Percutaneous coronary intervention Microchapters |
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PCI Complications |
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PCI in Specific Patients |
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PCI in Specific Lesion Types |
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Pharmacotherapy to Support PCI On the Web |
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American Roentgen Ray Society Images of Pharmacotherapy to Support PCI |
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Directions to Hospitals Treating Percutaneous coronary intervention |
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Risk calculators and risk factors for Pharmacotherapy to Support PCI |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pharmacotherapy to Support PCI
Antiplatelet Therapy to Support PCI
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease[1]
Recommendations for Duration of DAPT in Patients With ACS Treated With PCI
| Class I |
| "1.In patients with ACS treated with DAPT after BMS or DES implantation, P2Y12 inhibitor therapy (clopidogrel,
prasugrel, or ticagrelor) should be given for at least 12 months(Level of Evidence: B-R)" |
| "2.In patients treated with DAPT, a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is recommended(Level of Evidence: B-NR)" |
| Class IIa |
| "1.In patients with ACS treated with DAPT after coronary stent implantation, it is reasonable to use ticagrelor in preference to clopidogrel for maintenance P2Y12 inhibitor therapy(Level of Evidence: B-R)" |
| "2.In patients with ACS treated with DAPT after coronary stent implantation, who are not at high risk for bleeding complications and who do not have a history of stroke or TIA, it is reasonable to choose prasugrel over clopidogrel for maintenance P2Y12 inhibitor therapy ((Level of Evidence: B-R)" |
| Class IIb |
| "1.In patients with ACS treated with coronary stent implantation who have tolerated DAPT without bleeding complication and who are not at high bleeding risk (e.g., prior bleeding on DAPT, coagulopathy, oral anticoagulant use) continuation of DAPT for longer than 12 months may be reasonable(Level of Evidence: A SR)" |
| "2.In patients with ACS treated with DAPT after DES implantation who develop a high risk of bleeding (e.g., treatment with oral anticoagulant therapy), are at high risk of severe bleeding complication (e.g., major intracranial surgery), or develop significant overt bleeding, discontinuation of P2Y12 therapy after 6 months may be reasonable(Level of Evidence: C-LD)" |
| Class III (No Benefit) |
| "1.Prasugrel should not be administered to patients with a prior history of stroke or TIA(Level of Evidence: B-R)
" |
Antithrombin Therapy to Support PCI
Statin Therapy to Support PCI
References
- ↑ Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA; et al. (2016). "2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Thorac Cardiovasc Surg. 152 (5): 1243–1275. doi:10.1016/j.jtcvs.2016.07.044. PMID 27751237.