Antiplatelet Drug Use in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

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Wilbert S. Aronow, MD, FACC, FAHA

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Postgraduate Medicine:

Volume 125 No. 1

Category:

Clinical Focus

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DOI: 10.3810/pgm.2013.01.2624
Abstract: Patients with unstable angina pectoris/non–ST-segment elevation myocardial infarction have an acute coronary syndrome. These patients should be treated with dual antiplatelet therapy with the use of aspirin plus either clopidogrel, prasugrel, or ticagrelor, depending on the clinical circumstances. Prasugrel must not be used in patients with a history of stroke or transient ischemic attack. If ticagrelor is used, the dose of aspirin must not be > 100 mg daily. Platelet glycoprotein IIb/IIIa inhibitors should not be used as part of triple antiplatelet therapy if there is an increased risk for bleeding or in non–high-risk patients, such as those with a normal baseline cardiac troponin level, those without diabetes, and those aged ≥ 75 years for whom potential benefit may be significantly offset by the potential risk for bleeding. Clinical trial data do not support the use of intravenous cangrelor or oral vorapaxar in the treatment of patients with acute coronary syndromes.

Keywords: acute coronary syndromes; aspirin; clopidogrel; prasugrel; ticagrelor; platelet glycoprotein IIb/IIIa inhibitors; cangrelor; vorapaxar