The Living Guidelines: UA/NSTEMI Antiplatelet Therapy Suggest Revisions to the CLASS IIa Guidelines

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Class IIa Guidelines

 * 1) For UA / NSTEMI patients in whom an initial conservative strategy is selected and who have recurrent ischemic discomfort with clopidogrel, ASA, and anticoagulant therapy, it is reasonable to add a GP IIb/IIIa antagonist before diagnostic angiography. (Level of Evidence: C)
 * 2) For UA / NSTEMI patients in whom an initial invasive strategy is selected, it is reasonable to initiate antiplatelet therapy with both clopidogrel (loading dose followed by daily maintenance dose) and an intravenous GP IIb/IIIa inhibitor. (Level of Evidence: B)  Abciximab as the choice for upstream GP IIb/IIIa therapy is indicated only if there is no appreciable delay to coronary angiography and PCI is likely to be performed; otherwise, IV eptifibatide or tirofiban is the preferred choice of GP IIb/IIIa inhibitor. (Level of Evidence: B)
 * 3) For UA / NSTEMI patients in whom an initial invasive strategy is selected, it is reasonable to omit upstream administration of an intravenous GP IIb/IIIa antagonist before diagnostic angiography if bivalirudin is selected as the anticoagulant and at least 300 mg of clopidogrel was administered at least 6 h earlier than planned catheterization or PCI. (Level of Evidence: B)