Antiplatelet therapy to support PCI: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Blanked the page)
Tag: Blanking
Line 1: Line 1:
__NOTOC__
{{PCI}}
{{CMG}} {{AE}}{{AA}} {{Anahita}}
==Overview==
2011 AHA guidelines recommend the use of [[Antiplatelet drug|antiplatelet therapy]] with [[aspirin]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' and [[Antiplatelet drug|P2Y12 receptor inhibitor]] ([[clopidogrel]], [[prasugrel]] and [[ticagrelor]]) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' to support [[percutaneous coronary intervention]] ([[PCI]]) in [[patients]] with [[acute coronary syndromes]] ([[Acute coronary syndromes|ACS]]). Few [[Randomized controlled trial|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 effect (medicine)|adverse effects]]. Hence, a new large scale [[Randomized controlled trial|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 drug|antiplatelet therapy]] [[aspirin]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' and [[Antiplatelet drug|P2Y12 receptor inhibitor]] ([[clopidogrel]], [[prasugrel]] and [[ticagrelor]]) ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]].<ref name="pmid15738352">{{cite journal|author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=[[Circulation]]|volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352|doi=10.1161/01.CIR.0000157138.02645.11 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15738352 |accessdate=2011-12-13}}</ref><ref name="pmid16143698">{{cite journal|author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10 |pages=1224–32 |year=2005 |month=September |pmid=16143698|doi=10.1001/jama.294.10.1224 |url= |accessdate=2011-12-13}}</ref><ref name="pmid15234399">{{cite journal |author=van der Heijden DJ, Westendorp IC, Riezebos RK, Kiemeneij F, Slagboom T, van der Wieken LR, Laarman GJ |title=Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1 |pages=20–4 |year=2004 |month=July |pmid=15234399|doi=10.1016/j.jacc.2004.02.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S073510970400703X|accessdate=2011-12-13}}</ref><ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-13}}</ref> 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 effect (medicine)|adverse effects]]. Hence, a new large scale [[Randomized controlled trial|randomised open label trial]] called DUBIUS is in process in Italy comparing two new [[P2Y12 inhibitors]] [[prasugrel]] and [[ticagrelor]] for [[treatment|pretreatment]] in [[patients]] with [[non ST elevation MI]] undergoing [[PCI]]. It is a [[Randomized controlled trial|trial]] designed for superiority comparing downstream [[therapy]] over upstream [[therapy]] in terms of NACE (net [[adverse effect|adverse cardaic effect]]) and risk of major [[bleeding]] (BARC 3, 4 and 5). Another endpoint considered in the [[Randomized controlled trial|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="wikitable"
|-
| 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>
|-
| 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]].
2. A loading [[dose]] of [[P2Y12 inhibitor]], followed by daily [[dose|dosing]] is recommended to reduce [[ischemima|ischemic events]] in [[patients]] with [[ACS]] who are undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 1 Recommendation, Level of Evidence: C-LD <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>
|-
| bgcolor="yellow"|1. A loading [[dose]] of [[clopidogrel]], followed by daily [[dose|dosing]] is recommended to reduce [[ischemima|ischemic events]] in [[patients]] with [[chronic stable angina|stable ischemic heart disease]] ([[chronic stable angina|SIHD]]) who are undergoing [[PCI]].
2. A loading [[dose]] of 300 mg of [[clopidogrel]], followed by daily [[dose|dosing]] is recommended to reduce [[ischemima|ischemic events]] in [[patients]] undergoing [[PCI]] within 24 hours after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]].
|}


==2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]]|volume=58 |issue=24 |pages=2550–83 |year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
===Oral Antiplatelet Therapy (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients already taking daily [[Aspirin|aspirin therapy]] should take 81 mg to 325 mg before PCI.<ref name="pmid2954724">{{cite journal |author=Barnathan ES, Schwartz JS, Taylor L, Laskey WK, Kleaveland JP, Kussmaul WG, Hirshfeld JW |title=Aspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty |journal=[[Circulation]]|volume=76 |issue=1 |pages=125–34 |year=1987 |month=July |pmid=2954724 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=2954724|accessdate=2011-12-13}}</ref><ref name="pmid18819961">{{cite journal |author=Jolly SS, Pogue J, Haladyn K, Peters RJ, Fox KA, Avezum A, Gersh BJ, Rupprecht HJ, Yusuf S, Mehta SR |title=Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study |journal=[[European Heart Journal]] |volume=30 |issue=8 |pages=900–7|year=2009 |month=April |pmid=18819961 |doi=10.1093/eurheartj/ehn417|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18819961|accessdate=2011-12-13}}</ref><ref name="pmid15383485">{{cite journal |author=Popma JJ, Berger P, Ohman EM, Harrington RA, Grines C, Weitz JI |title=Antithrombotic therapy during percutaneous coronary intervention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy|journal=[[Chest]] |volume=126 |issue=3 Suppl |pages=576S–599S |year=2004 |month=September|pmid=15383485 |doi=10.1378/chest.126.3_suppl.576S |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=15383485 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients not on [[Aspirin|aspirin therapy]] should be given non-[[enteric]] aspirin 325 mg before PCI.<ref name="pmid2954724">{{cite journal |author=Barnathan ES, Schwartz JS, Taylor L, Laskey WK, Kleaveland JP, Kussmaul WG, Hirshfeld JW |title=Aspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty |journal=[[Circulation]]|volume=76 |issue=1 |pages=125–34 |year=1987 |month=July |pmid=2954724 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=2954724|accessdate=2011-12-13}}</ref><ref name="pmid15383485">{{cite journal |author=Popma JJ, Berger P, Ohman EM, Harrington RA, Grines C, Weitz JI |title=Antithrombotic therapy during percutaneous coronary intervention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy|journal=[[Chest]] |volume=126 |issue=3 Suppl |pages=576S–599S |year=2004 |month=September|pmid=15383485 |doi=10.1378/chest.126.3_suppl.576S |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=15383485 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' After PCI, use of [[aspirin]] should be continued indefinitely.<ref name="pmid8598866">{{cite journal |author=Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann-Roth EM, Richardt G, Alt E, Schmitt C, Ulm K |title=A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents|journal=[[The New England Journal of Medicine]] |volume=334 |issue=17 |pages=1084–9 |year=1996|month=April |pmid=8598866 |doi=10.1056/NEJM199604253341702|url=http://dx.doi.org/10.1056/NEJM199604253341702 |accessdate=2011-12-13}}</ref><ref name="pmid11786451">{{cite journal |author= |title=Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients |journal=[[BMJ (Clinical Research Ed.)]] |volume=324 |issue=7329 |pages=71–86 |year=2002|month=January |pmid=11786451 |pmc=64503 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=11786451 |accessdate=2011-12-13}}</ref><ref name="pmid19482214">{{cite journal|author=Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A |title=Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials |journal=[[Lancet]] |volume=373 |issue=9678 |pages=1849–60 |year=2009|month=May |pmid=19482214 |pmc=2715005 |doi=10.1016/S0140-6736(09)60503-1|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)60503-1|accessdate=2011-12-13}}</ref><ref name="pmid16702489">{{cite journal |author=Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA |title=AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute |journal=[[Circulation]] |volume=113 |issue=19|pages=2363–72 |year=2006 |month=May |pmid=16702489 |doi=10.1161/CIRCULATIONAHA.106.174516|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16702489|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' A [[loading dose]] of a [[Antiplatelet drug|P2Y12 receptor inhibitor]] should be given to patients undergoing PCI with [[Stent|stenting]].<ref name="pmid15738352">{{cite journal|author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=[[Circulation]]|volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352|doi=10.1161/01.CIR.0000157138.02645.11 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15738352 |accessdate=2011-12-13}}</ref><ref name="pmid16143698">{{cite journal|author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10 |pages=1224–32 |year=2005 |month=September |pmid=16143698|doi=10.1001/jama.294.10.1224 |url= |accessdate=2011-12-13}}</ref><ref name="pmid15234399">{{cite journal |author=van der Heijden DJ, Westendorp IC, Riezebos RK, Kiemeneij F, Slagboom T, van der Wieken LR, Laarman GJ |title=Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1 |pages=20–4 |year=2004 |month=July |pmid=15234399|doi=10.1016/j.jacc.2004.02.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S073510970400703X|accessdate=2011-12-13}}</ref><ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' Options include:
:'''a.''' [[Clopidogrel]] 600 mg ([[acute coronary syndrome|ACS]] and non-[[ACS]] patients).<ref name="pmid15738352">{{cite journal |author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=[[Circulation]] |volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March|pmid=15738352 |doi=10.1161/01.CIR.0000157138.02645.11|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15738352|accessdate=2011-12-13}}</ref><ref name="pmid15738352">{{cite journal|author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=[[Circulation]]|volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352|doi=10.1161/01.CIR.0000157138.02645.11 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15738352 |accessdate=2011-12-13}}</ref><ref name="pmid16143698">{{cite journal|author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10 |pages=1224–32 |year=2005 |month=September |pmid=16143698|doi=10.1001/jama.294.10.1224 |url= |accessdate=2011-12-13}}</ref><ref name="pmid15234399">{{cite journal |author=van der Heijden DJ, Westendorp IC, Riezebos RK, Kiemeneij F, Slagboom T, van der Wieken LR, Laarman GJ |title=Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1 |pages=20–4 |year=2004 |month=July |pmid=15234399|doi=10.1016/j.jacc.2004.02.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S073510970400703X|accessdate=2011-12-13}}</ref><ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-13}}</ref><ref name="pmid16143698">{{cite journal |author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10|pages=1224–32 |year=2005 |month=September |pmid=16143698 |doi=10.1001/jama.294.10.1224 |url=|accessdate=2011-12-13}}</ref><ref name="pmid15234399">{{cite journal |author=van der Heijden DJ, Westendorp IC, Riezebos RK, Kiemeneij F, Slagboom T, van der Wieken LR, Laarman GJ |title=Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1|pages=20–4 |year=2004 |month=July |pmid=15234399 |doi=10.1016/j.jacc.2004.02.056|url=http://linkinghub.elsevier.com/retrieve/pii/S073510970400703X |accessdate=2011-12-13}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
:'''b.''' [[Prasugrel]] 60 mg ([[ACS]] patients).<ref name="pmid15738352">{{cite journal|author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=[[Circulation]]|volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352|doi=10.1161/01.CIR.0000157138.02645.11 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15738352 |accessdate=2011-12-13}}</ref><ref name="pmid16143698">{{cite journal|author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10 |pages=1224–32 |year=2005 |month=September |pmid=16143698|doi=10.1001/jama.294.10.1224 |url= |accessdate=2011-12-13}}</ref><ref name="pmid15234399">{{cite journal |author=van der Heijden DJ, Westendorp IC, Riezebos RK, Kiemeneij F, Slagboom T, van der Wieken LR, Laarman GJ |title=Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1 |pages=20–4 |year=2004 |month=July |pmid=15234399|doi=10.1016/j.jacc.2004.02.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S073510970400703X|accessdate=2011-12-13}}</ref><ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-13}}</ref><ref name="pmid17982182">{{cite journal|author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November |pmid=17982182|doi=10.1056/NEJMoa0706482 |url=http://dx.doi.org/10.1056/NEJMoa0706482|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
:'''c.''' [[Ticagrelor]] 180 mg ([[ACS]] patients).<ref name="pmid19717846">{{cite journal|author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M|title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11 |pages=1045–57 |year=2009 |month=September|pmid=19717846 |doi=10.1056/NEJMoa0904327 |url=http://dx.doi.org/10.1056/NEJMoa0904327|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' The [[loading dose]] of [[clopidogrel]] for patients undergoing PCI after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]] should be 300 mg within 24 hours and 600 mg more than 24 hours after receiving [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]].<ref name="pmid16143698">{{cite journal |author=Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Lewis BS, Murphy SA, McCabe CH, Braunwald E |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 : the Journal of the American Medical Association]] |volume=294 |issue=10|pages=1224–32 |year=2005 |month=September |pmid=16143698 |doi=10.1001/jama.294.10.1224 |url=|accessdate=2011-12-13}}</ref><ref name="pmid16271642">{{cite journal |author=Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, Collins R, Liu LS |title=Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial|journal=[[Lancet]] |volume=366 |issue=9497 |pages=1607–21 |year=2005 |month=November |pmid=16271642|doi=10.1016/S0140-6736(05)67660-X|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(05)67660-X|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Patients should be counseled on the need for and risks of [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] before placement of [[Stent|intra-coronary stents]], especially [[drug eluting stent|drug eluting stents (DES)]], and alternative [[therapy|therapies]] should be pursued if patients are unwilling or unable to comply with the recommended duration of [[dual antiplatelet therapy|dual antiplatelet therapy]].<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February|pmid=17291948 |doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' The duration of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] after [[Stent|stent implantation]] should generally be as follows:
:'''a.''' In patients receiving a [[stent]] ([[Bare metal stent|bare metal stent (BMS)]] or [[drug eluting stent|drug eluting stent (DES)]]) during PCI for [[ACS]], [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] should be given for at least 12 months. Options include [[clopidogrel]] 75 mg daily <ref name="pmid11520521">{{cite journal |author=Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA|title=Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study |journal=[[Lancet]]|volume=358 |issue=9281 |pages=527–33 |year=2001 |month=August |pmid=11520521 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0140673601057014 |accessdate=2011-12-13}}</ref>,[[prasugrel]] 10 mg daily <ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref>, and [[ticagrelor]] 90 mg twice daily.<ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]]|volume=361 |issue=11 |pages=1045–57 |year=2009 |month=September |pmid=19717846|doi=10.1056/NEJMoa0904327 |url=http://dx.doi.org/10.1056/NEJMoa0904327|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
:'''b.''' In patients receiving [[drug eluting stent|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]].<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February|pmid=17291948 |doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-13}}</ref><ref name="pmid18534267">{{cite journal |author=Brar SS, Kim J, Brar SK, Zadegan R, Ree M, Liu IL, Mansukhani P, Aharonian V, Hyett R, Shen AY |title=Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions|journal=[[Journal of the American College of Cardiology]] |volume=51 |issue=23 |pages=2220–7|year=2008 |month=June |pmid=18534267 |doi=10.1016/j.jacc.2008.01.063|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)01051-6|accessdate=2011-12-13}}</ref><ref name="pmid17148711">{{cite journal |author=Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM |title=Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation |journal=[[JAMA : the Journal of the American Medical Association]]|volume=297 |issue=2 |pages=159–68 |year=2007 |month=January |pmid=17148711|doi=10.1001/jama.297.2.joc60179 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17148711 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
:'''c.''' In patients receiving [[Bare metal stent|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).<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948|doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-13}}</ref><ref name="pmid12435254">{{cite journal |author=Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C, Topol EJ |title=Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=288 |issue=19 |pages=2411–20 |year=2002|month=November |pmid=12435254 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12435254 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Prasugrel]] should not be administered to patients with a prior history of [[stroke]] or [[transient ischemic attack]].<ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' After PCI, it is reasonable to use [[aspirin]] 81 mg per day in preference to higher maintenance [[dose]]s.<ref name="pmid18819961">{{cite journal |author=Jolly SS, Pogue J, Haladyn K, Peters RJ, Fox KA, Avezum A, Gersh BJ, Rupprecht HJ, Yusuf S, Mehta SR |title=Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study |journal=[[European Heart Journal]] |volume=30 |issue=8 |pages=900–7 |year=2009|month=April |pmid=18819961 |doi=10.1093/eurheartj/ehn417|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18819961|accessdate=2011-12-13}}</ref><ref name="pmid18574266">{{cite journal |author=Patrono C, Baigent C, Hirsh J, Roth G |title=Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl|pages=199S–233S |year=2008 |month=June |pmid=18574266 |doi=10.1378/chest.08-0672|url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574266|accessdate=2011-12-13}}</ref><ref name="pmid19293071">{{cite journal |author=Steinhubl SR, Bhatt DL, Brennan DM, Montalescot G, Hankey GJ, Eikelboom JW, Berger PB, Topol EJ |title=Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding |journal=[[Annals of Internal Medicine]] |volume=150 |issue=6 |pages=379–86 |year=2009|month=March |pmid=19293071 |doi= |url= |accessdate=2011-12-13}}</ref><ref name="pmid15877994">{{cite journal |author=Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Baggish JS, Bhatt DL, Topol EJ |title=Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials |journal=[[The American Journal of Cardiology]] |volume=95 |issue=10 |pages=1218–22 |year=2005 |month=May|pmid=15877994 |doi=10.1016/j.amjcard.2005.01.049|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)00294-8|accessdate=2011-12-13}}</ref><ref name="pmid14504182">{{cite journal |author=Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, Diaz R, Commerford PJ, Valentin V, Yusuf S |title=Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study |journal=[[Circulation]] |volume=108 |issue=14 |pages=1682–7 |year=2003 |month=October|pmid=14504182 |doi=10.1161/01.CIR.0000091201.39590.CB|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14504182|accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' If the risk of [[morbidity]] from [[bleeding]] outweighs the anticipated benefit afforded by a recommended duration of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] after [[Stent|stent implantation]], earlier discontinuation (e.g.,less than 12 months) of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Continuation of [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] beyond 12 months may be considered in patients undergoing [[drug eluting stent|drug eluting stent (DES)]] implantation.<ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20|pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-13}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-13}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Dual Antiplatelet Therapy Compliance and Stent Thrombosis (DO NOT EDIT) <ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]]|volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''1.''' PCI with [[coronary stent]]ing ([[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. <ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]]|volume=49 |issue=6 |pages=734–9 |year=2007 |month=February|pmid=17291948|doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-06}}</ref><ref name="pmid9834303">{{cite journal |author=Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, Giambartolomei A, Diver DJ, Lasorda DM, Williams DO, Pocock SJ, Kuntz RE |title=A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators |journal=[[The New England Journal of Medicine]] |volume=339 |issue=23 |pages=1665–71|year=1998 |month=December |pmid=9834303|doi=10.1056/NEJM199812033392303|url=http://dx.doi.org/10.1056/NEJM199812033392303|accessdate=2011-12-06}}</ref><ref name="pmid17296821">{{cite journal |author=Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE |title=Stent thrombosis in randomized clinical trials of drug-eluting stents |journal=[[The New England Journal of Medicine]] |volume=356 |issue=10|pages=1020–9 |year=2007 |month=March |pmid=17296821|doi=10.1056/NEJMoa067731|url=http://dx.doi.org/10.1056/NEJMoa067731 |accessdate=2011-12-06}}</ref><ref name="pmid15500897">{{cite journal|author=McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler LF, Waksman R, Serruys PW |title=Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy |journal=[[Lancet]]|volume=364 |issue=9444 |pages=1519–21 |year=2004|pmid=15500897|doi=10.1016/S0140-6736(04)17275-9|url=http://linkinghub.elsevier.com/retrieve/pii/S0140673604172759|accessdate=2011-12-06}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
==References==
{{reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[CME Category::Cardiology]]
[[Category:Cardiology]]
[[Category:Cardiovascular Drugs]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
[[Category:Needs overview]]

Revision as of 16:13, 10 July 2022

Retrieved from "https://www.wikidoc.org/index.php?title=Antiplatelet_therapy_to_support_PCI&oldid=1727529"