Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy

==ACC / AHA Guidelines - Antiplatelet Therapy(DO NOT EDIT) ==
 * Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

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Class I
1. For UA/NSTEMI patients treated medically without stenting,aspirinΦ (75 to 162 mg per day) should be prescribed indefinitely (Level of Evidence: A) clopidogrel† (75 mg per day) should be prescribed for at least 1 month and ideally for up to 1 year. (Level of Evidence: B)

2. Clopidogrel 75 mg daily (preferred) or ticlopidine (in the absence of contraindications) should be given to patients recovering from UA / NSTEMI whenASA is contraindicated or not tolerated because of hypersensitivity or GI intolerance (despite use of gastroprotective agents such as PPIs). (Level of Evidence: A)

Class IIa
1. For UA/NSTEMI patients in whom the physician is concerned about the risk of bleeding, a lower initial aspirin dose after PCI of 75 to 162 mg per day is reasonable. (Level of Evidence: C)

Class IIb
1. For UA/NSTEMI patients who have an indication for anticoagulation, addwarfarin‡ to maintain an international normalization ratio of 2.0 to 3.0.§(Level of Evidence: B)

2. Continuation of clopidogrel or prasugrel beyond 15 months may be considered in patients following DES placement. (Level of Evidence: C)

Class III
1. Dipyridamole is not recommended as an antiplatelet agent in post-UA/NSTEMI patients because it has not been shown to be effective. (Level of Evidence: B)

Φ In patients allergic to ASA, clopidogrel alone can be used or ASA desensitization can be tried.

† For patients allergic to clopidogrel, ticlopidine 250mg orally twice daily is recommended.

‡ Continue ASA indefinitely and warfarin longer term as indicated for specific conditions such as atrial fibrillation; LV thrombus; or cerebral, venous, or pulmonary emboli.

§ An INR of 2.0 to 2.5 is preferable while given with ASA and clopidogrel, especially in older patients and those with other risk factors for bleeding. For UA/NSTEMI patients who have mechanical heart valves, the INR should be at least 2.5 (based on type of prosthesis).}}