15
Table 11. Myocardial Revascularization (cont'd)
Recommendations
COR LOE
In patients receiving a stent (bare-metal stent or DES) during PCI for
NSTE-ACS, P2Y
12
inhibitor therapy should be given for ≥12 months.
Options include:
• Clopidogrel: 75 mg daily or
• Prasugrel:
a
10 mg daily or
• Ticagrelor:
b
90 mg twice daily
I B
It is reasonable to choose ticagrelor over clopidogrel for P2Y
12
inhibition treatment in patients with NSTE-ACS treated with an
early invasive strateg y and/or coronary stenting.
IIa B
It is reasonable to choose prasugrel over clopidogrel for P2Y
12
treatment in patients with NSTE-ACS who undergo PCI who are
not at high risk of bleeding complications.
IIa B
In patients with NSTE-ACS and high-risk features (e.g., elevated
troponin) treated with UFH and adequately pretreated with
clopidogrel, it is reasonable to administer a GPI (abciximab, double-
bolus eptifibatide, or high-dose bolus tirofiban) at the time of PCI.
IIa B
Aer PCI, it is reasonable to use 81 mg per day of ASA in preference
to higher maintenance doses.
IIa B
If the risk of morbidity from bleeding outweighs the anticipated
benefit of a recommended duration of P2Y
12
inhibitor therapy aer
stent implantation, earlier discontinuation (e.g., <12 months) of
P2Y
12
inhibitor therapy is reasonable.
IIa C
Continuation of DAPT beyond 12 months may be considered in
patients undergoing stent implantation.
IIb C
Prasugrel should NOT be administered to patients with a prior
history of stroke or transient ischemic attack.
III:
Harm
B
PCI—GPIs
In patients with NSTE-ACS and high-risk features (e.g., elevated
troponin) and not adequately pretreated with clopidogrel or
ticagrelor, it is useful to administer a GPI (abciximab, double-bolus
eptifibatide, or high-dose bolus tirofiban) at the time of PCI.
I A
In patients with NSTE-ACS and high-risk features (e.g., elevated
troponin) treated with UFH and adequately pretreated with
clopidogrel, it is reasonable to administer a GPI (abciximab, double-
bolus eptifibatide, or high-dose bolus tirofiban) at the time of PCI.
IIa B
Anticoagulant therapy in patients undergoing PCI
An anticoagulant should be administered to patients with NSTE-
ACS undergoing PCI to reduce the risk of intracoronary and catheter
thrombus formation.
I C
Intravenous UFH is useful in patients with NSTE-ACS undergoing PCI. I C
a
Patients should receive a loading dose of prasugrel provided that they were not pretreated with
another P2Y
12
receptor inhibitor.
b
e recommended maintenance dose of ASA to be used with ticagrelor is 81 mg daily.
