The Living Guidelines: UA/NSTEMI Antiplatelet Therapy Polling Results for 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)  Antiplatelet Therapy CLASS IIa Recommendation 1 should be: CLASS I CLASS IIa CLASS IIb CLASS III

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) Abciximabas the choice for upstream GP IIb/IIIa therapy is indicated only if there is no appreciable delay to 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)  Antiplatelet Therapy CLASS IIa Recommendation 2 should be: CLASS I CLASS IIa CLASS IIb CLASS III

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)  Antiplatelet Therapy CLASS IIa Recommendation 3 should be: CLASS I CLASS IIa CLASS IIb CLASS III