ÎÎIn patients with definite UA/NSTEMI undergoing PCI as part of
an early invasive strategy, the use of a 600-mg loading dose of
clopidogrel, followed by a higher maintenance dose of 150 mg daily
for 6 days, then 75 mg daily, may be reasonable in patients not
considered at high risk for bleeding. (IIb-B)
ÎÎAbciximab should NOT be administered to patients in whom PCI is not
planned. (III: No Benefit-A)
ÎÎIn UA/NSTEMI patients who are at low risk for ischemic events (eg,
TIMI risk score ≤2) or at high risk of bleeding and who are already
receiving ASA and a P2Y12 receptor inhibitor, upstream GP IIb/IIIa
inhibitors are NOT recommended. (III: No Benefit-B)
ÎÎIn UA/NSTEMI patients with a prior history of stroke and/or transient
ischemic attack (TIA) for whom PCI is planned, prasugrelb is
potentially harmful as part of a dual antiplatelet therapy regimen.
(III: Harm-B)
a
b
Applies to patients who were not treated chronically with these medications.
See Table 3.
Anticoagulant Therapy
ÎÎAnticoagulant therapy should be added to antiplatelet therapy in UA/
NSTEMI patients as soon as possible after presentation (Fig. 2).
• For patients in whom an invasive strategy is selected, regimens with established
efficacy at a Level of Evidence A include enoxaparin and unfractionated heparin
(UFH), and those with established efficacy at a Level of Evidence B include
bivalirudin and fondaparinux.
• For patients in whom a conservative strategy is selected, regimens using either
enoxaparina or UFH (I-A) or fondaparinux (I-B) have established efficacy.
• In patients in whom a conservative strategy is selected and who have an
increased risk of bleeding, fondaparinux is preferable. (I-B)
ÎÎFor UA/NSTEMI patients in whom an initial conservative strategy
is selected, enoxaparin a or fondaparinux is preferable to UFH as
anticoagulant therapy, unless CABG is planned within 24 h. (IIa-B)
a
Limited data are available for the use of other low-molecular-weight heparins.
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