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]]===
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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><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]].
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]].
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| 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><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="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="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="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><ref name="pmid10931801">{{cite journal| author=Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, CLASSICS Investigators| title=Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting : the clopidogrel aspirin stent international cooperative study (CLASSICS). | journal=Circulation | year= 2000 | volume= 102 | issue= 6 | pages= 624-9 | pmid=10931801 | doi=10.1161/01.cir.102.6.624 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10931801  }} </ref><ref name="pmid12435254">{{cite journal| author=Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C | display-authors=etal| title=Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. | journal=JAMA | year= 2002 | volume= 288 | issue= 19 | pages= 2411-20 | pmid=12435254 | doi=10.1001/jama.288.19.2411 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12435254  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12841706 Review in: ACP J Club. 2003 Jul-Aug;139(1):2] </ref><ref name="pmid16260639">{{cite journal| author=von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A| title=Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial. | journal=Circulation | year= 2005 | volume= 112 | issue= 19 | pages= 2946-50 | pmid=16260639 | doi=10.1161/CIRCULATIONAHA.105.559088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16260639  }} </ref>
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| 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]].
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| colspan="1" style="text-align:center; background:orange"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]], 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><ref name="pmid22447888">{{cite journal| author=Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH | display-authors=etal| title=Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. | journal=JAMA | year= 2012 | volume= 307 | issue= 17 | pages= 1817-26 | pmid=22447888 | doi=10.1001/jama.2012.421 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447888  }} </ref><ref name="pmid11419426">{{cite journal| author=Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P | display-authors=etal| title=Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 25 | pages= 1895-903 | pmid=11419426 | doi=10.1056/NEJM200106213442503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11419426  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=11985430 Review in: ACP J Club. 2002 May-Jun;136(3):89] </ref>
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|bgcolor="orange"|[[Intravenous]] [[glycoprotein IIb/IIIa inhibitors]] are a reasonable choice in order to improve procedural success in [[patients]] with [[ACS]] who are undergoing [[PCI]] and have a large [[thrombus]] burden, no-reflow, or slow flow.
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| colspan="1" style="text-align:center; background:Lightblue"|Class 2b 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="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="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="pmid19249633">{{cite journal| author=Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH | display-authors=etal| title=Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. | journal=Lancet | year= 2009 | volume= 373 | issue= 9665 | pages= 723-31 | pmid=19249633 | doi=10.1016/S0140-6736(09)60441-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19249633  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19528555 Review in: Ann Intern Med. 2009 Jun 16;150(12):JC6-10] </ref><ref name="pmid19915222">{{cite journal| author=Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G | display-authors=etal| title=Intravenous platelet blockade with cangrelor during PCI. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 24 | pages= 2330-41 | pmid=19915222 | doi=10.1056/NEJMoa0908629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19915222  }} </ref><ref name="pmid23473369">{{cite journal| author=Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW | display-authors=etal| title=Effect of platelet inhibition with cangrelor during PCI on ischemic events. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 14 | pages= 1303-13 | pmid=23473369 | doi=10.1056/NEJMoa1300815 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473369  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=23778929 Review in: Ann Intern Med. 2013 Jun 18;158(12):JC5] </ref><ref name="pmid24011551">{{cite journal| author=Steg PG, Bhatt DL, Hamm CW, Stone GW, Gibson CM, Mahaffey KW | display-authors=etal| title=Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. | journal=Lancet | year= 2013 | volume= 382 | issue= 9909 | pages= 1981-92 | pmid=24011551 | doi=10.1016/S0140-6736(13)61615-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24011551  }} </ref>
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| bgcolor="lightblue"|1. Using [[ticagrelor]] or [[prasugrel]] is preferred to [[clopidogrel]] in order to decrease [[ischemia|ischemic events]] (including [[stent thrombosis]]) in [[ACS]] [[patients]] undergoing [[PCI]].
2. [[Intravenous]] [[cangrelor]] is recommended in order to reduce [[surgery|periprocedural]] [[ischemia|ischemic events]] among [[P2Y12 inhibitor]] naïve [[patients]] who are undergoing [[PCI]].
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| colspan="1" style="text-align:center; background:lightgray"|Class 2b 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>
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| bgcolor="lightgray"|[[Ticagrelor]] could be a reasonable alternative over [[clopidogrel]] in order to decrease [[ischemia|ischemic events]] in [[patients]] [[Old age|older]] than 75 years [[Old age|old]] who are undergoing [[PCI]] within 24 hours after [[fibrinolytic therapy]].
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:lightpink"|Class 3 Recommendation: HARM, 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="pmid14724302">{{cite journal| author=Kastrati A, Mehilli J, Schühlen H, Dirschinger J, Dotzer F, ten Berg JM | display-authors=etal| title=A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 3 | pages= 232-8 | pmid=14724302 | doi=10.1056/NEJMoa031859 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14724302  }} </ref><ref name="pmid11368699">{{cite journal| author=O'Shea JC, Hafley GE, Greenberg S, Hasselblad V, Lorenz TJ, Kitt MM | display-authors=etal| title=Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial: a randomized controlled trial. | journal=JAMA | year= 2001 | volume= 285 | issue= 19 | pages= 2468-73 | pmid=11368699 | doi=10.1001/jama.285.19.2468 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11368699  }} </ref><ref name="pmid11145489">{{cite journal| author=ESPRIT Investigators. Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy| title=Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. | journal=Lancet | year= 2000 | volume= 356 | issue= 9247 | pages= 2037-44 | pmid=11145489 | doi=10.1016/S0140-6736(00)03400-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11145489  }} </ref>
|-
| bgcolor="lightpink"|1. [[Prasugrel]] should not be administered in [[patients]] with a history of [[stroke]] or [[transient ischemic attack]] who are undergoing [[PCI]].
2. The routine use of an [[intravenous]] [[glycoprotein IIb/IIIa inhibitor]] is not recommended in [[patients]] with stable [[ischemic heart disease]] undergoing [[PCI]].
|}
==2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease==
==2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease==


Revision as of 20:34, 27 July 2022

Percutaneous coronary intervention Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pharmacotherapy to Support PCI

Antiplatelet Therapy to Support PCI

Class 1 Recommendation, Level of Evidence: ‌B-R[1][2][3][4][5][6][7][8][9][10][11][12][13][14]
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 [1][5][8][11][14][15][16][17]
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.

Class IIa, Level of Evidence: ‌C-LD[1][18][19]
Intravenous glycoprotein IIb/IIIa inhibitors are a reasonable choice in order to improve procedural success in patients with ACS who are undergoing PCI and have a large thrombus burden, no-reflow, or slow flow.
Class 2b Recommendation, Level of Evidence: B-R [1][6][13][20][21][22][23]
1. Using ticagrelor or prasugrel is preferred to clopidogrel in order to decrease ischemic events (including stent thrombosis) in ACS patients undergoing PCI.

2. Intravenous cangrelor is recommended in order to reduce periprocedural ischemic events among P2Y12 inhibitor naïve patients who are undergoing PCI.

Class 2b Recommendation, Level of Evidence: B-R[1]
Ticagrelor could be a reasonable alternative over clopidogrel in order to decrease ischemic events in patients older than 75 years old who are undergoing PCI within 24 hours after fibrinolytic therapy.
Class 3 Recommendation: HARM, Level of Evidence: B-R[1][24][25][26]
1. Prasugrel should not be administered in patients with a history of stroke or transient ischemic attack who are undergoing PCI.

2. The routine use of an intravenous glycoprotein IIb/IIIa inhibitor is not recommended in patients with stable ischemic heart disease undergoing PCI.

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease

Recommendations for Duration of DAPT in Patients With ACS Treated With PCI[27]

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

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "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". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  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. doi:10.1136/bmj.324.7329.71. PMC 64503. PMID 11786451. Review in: ACP J Club. 2002 Jul-Aug;137(1):5
  3. ↑ "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. 1994. PMC 2539220. PMID 8298418.
  4. ↑ Antithrombotic Trialists' (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J; et al. (2009). "Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials". Lancet. 373 (9678): 1849–60. doi:10.1016/S0140-6736(09)60503-1. PMC 2715005. PMID 19482214. Review in: Ann Intern Med. 2009 Sep 15;151(6):JC3-4, JC3-5 Review in: Evid Based Med. 2009 Dec;14(6):172-3
  5. ↑ 5.0 5.1 Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P; et al. (2005). "Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study". JAMA. 294 (10): 1224–32. doi:10.1001/jama.294.10.1224. PMID 16143698. Review in: ACP J Club. 2006 Mar-Apr;144(2):29
  6. ↑ 6.0 6.1 Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S; et al. (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182.
  7. ↑ Montalescot G, van 't Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L; et al. (2014). "Prehospital ticagrelor in ST-segment elevation myocardial infarction". N Engl J Med. 371 (11): 1016–27. doi:10.1056/NEJMoa1407024. PMID 25175921.
  8. ↑ 8.0 8.1 Taniuchi M, Kurz HI, Lasala JM (2001). "Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population". Circulation. 104 (5): 539–43. doi:10.1161/hc3001.093435. PMID 11479250.
  9. ↑ Bellemain-Appaix A, O'Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O; et al. (2012). "Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis". JAMA. 308 (23): 2507–16. doi:10.1001/jama.2012.50788. PMID 23287889.
  10. ↑ Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M; et al. (1996). "A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents". N Engl J Med. 334 (17): 1084–9. doi:10.1056/NEJM199604253341702. PMID 8598866.
  11. ↑ 11.0 11.1 Moussa I, Oetgen M, Roubin G, Colombo A, Wang X, Iyer S; et al. (1999). "Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation". Circulation. 99 (18): 2364–6. doi:10.1161/01.cir.99.18.2364. PMID 10318654.
  12. ↑ Calver AL, Blows LJ, Harmer S, Dawkins KD, Gray HH, Morgan JH; et al. (2000). "Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents". Am Heart J. 140 (3): 483–91. doi:10.1067/mhj.2000.108825. PMID 10966552.
  13. ↑ 13.0 13.1 Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C; et al. (2009). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-4
  14. ↑ 14.0 14.1 Müller C, Büttner HJ, Petersen J, Roskamm H (2000). "A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents". Circulation. 101 (6): 590–3. doi:10.1161/01.cir.101.6.590. PMID 10673248.
  15. ↑ Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, CLASSICS Investigators (2000). "Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting : the clopidogrel aspirin stent international cooperative study (CLASSICS)". Circulation. 102 (6): 624–9. doi:10.1161/01.cir.102.6.624. PMID 10931801.
  16. ↑ Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C; et al. (2002). "Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial". JAMA. 288 (19): 2411–20. doi:10.1001/jama.288.19.2411. PMID 12435254. Review in: ACP J Club. 2003 Jul-Aug;139(1):2
  17. ↑ von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A (2005). "Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial". Circulation. 112 (19): 2946–50. doi:10.1161/CIRCULATIONAHA.105.559088. PMID 16260639.
  18. ↑ Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH; et al. (2012). "Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial". JAMA. 307 (17): 1817–26. doi:10.1001/jama.2012.421. PMID 22447888.
  19. ↑ Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P; et al. (2001). "Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction". N Engl J Med. 344 (25): 1895–903. doi:10.1056/NEJM200106213442503. PMID 11419426. Review in: ACP J Club. 2002 May-Jun;136(3):89
  20. ↑ Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH; et al. (2009). "Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial". Lancet. 373 (9665): 723–31. doi:10.1016/S0140-6736(09)60441-4. PMID 19249633. Review in: Ann Intern Med. 2009 Jun 16;150(12):JC6-10
  21. ↑ Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G; et al. (2009). "Intravenous platelet blockade with cangrelor during PCI". N Engl J Med. 361 (24): 2330–41. doi:10.1056/NEJMoa0908629. PMID 19915222.
  22. ↑ Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW; et al. (2013). "Effect of platelet inhibition with cangrelor during PCI on ischemic events". N Engl J Med. 368 (14): 1303–13. doi:10.1056/NEJMoa1300815. PMID 23473369. Review in: Ann Intern Med. 2013 Jun 18;158(12):JC5
  23. ↑ Steg PG, Bhatt DL, Hamm CW, Stone GW, Gibson CM, Mahaffey KW; et al. (2013). "Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data". Lancet. 382 (9909): 1981–92. doi:10.1016/S0140-6736(13)61615-3. PMID 24011551.
  24. ↑ Kastrati A, Mehilli J, Schühlen H, Dirschinger J, Dotzer F, ten Berg JM; et al. (2004). "A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel". N Engl J Med. 350 (3): 232–8. doi:10.1056/NEJMoa031859. PMID 14724302.
  25. ↑ O'Shea JC, Hafley GE, Greenberg S, Hasselblad V, Lorenz TJ, Kitt MM; et al. (2001). "Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial: a randomized controlled trial". JAMA. 285 (19): 2468–73. doi:10.1001/jama.285.19.2468. PMID 11368699.
  26. ↑ ESPRIT Investigators. Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (2000). "Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial". Lancet. 356 (9247): 2037–44. doi:10.1016/S0140-6736(00)03400-0. PMID 11145489.
  27. ↑ 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.

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