Antiplatelet agents for acute coronary syndrome

The recommendations are from the Canadian Cardiovascular Society (CCS),6,7 the American Heart Association (AHA),8 the American College of Cardiology (ACC),9-11 the American College of Chest Physicians (ACCP),12,13 the Institute for Clinical Systems Improvement (ICSI),14 the European Society of Cardiology (ESC),16 the National Institute for Health and Clinical Excellence (NICE),17 and the Scottish [...] Of the remaining seven guidelines on the use of antiplatelets in specific patient groups, three reported on ACS,8,14,15,18 one on STEMI and PCI,9 two on UA and NSTEMI,10,17 and two on NSTEMI.13,16 Interventions All guidelines provided recommendations on the use of aspirin and clopidogrel in ACS patients. [...] UA and NSTEMI patients selected for an invasive approach should receive ASA on presentation and clopidogrel or prasugrel at the time of PCI.9,16 UA and NSTEMI patients selected for CABG should discontinue clopidogrel five days before surgery.10,16. [...] Following PCI with a BMS, the guideline recommends ASA indefinitely (75-162 mg/d) and clopidogrel (75 mg/d) for at least one month and up to 12 months in the absence of bleeding.6,7 DES patients should receive clopidogrel (75 mg/d) for 12 months and ASA indefinitely. [...] Dual antiplatelet therapy, with ASA and clopidogrel, can be continued beyond a year in patients with high thrombotic risk and low risk of bleeding.6,7 Prasugrel (10 mg/d) is recommended in addition to ASA in patients with ACS, but should be avoided in elderly patients with an increased risk of bleeding and those with a history of stroke.6,7 Patients taking clopidogrel who are at increased risk of