Antiplatelet agents in acute non-ST elevation acute coronary syndromes
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- A Michael Lincoff, MD
A Michael Lincoff, MD
- Director, Center for Clinical Research
- Professor of Medicine
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
- Section Editors
- Christopher P Cannon, MD
Christopher P Cannon, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Harvard Medical School
- Freek Verheugt, MD, FACC, FESC
Freek Verheugt, MD, FACC, FESC
- Section Editor — Coronary Heart Disease
- Onze Lieve Vrouwe Gasthuis, Netherlands
Rupture of an atherosclerotic plaque is the usual initiating event in an acute coronary syndrome. Plaque rupture often leads to thrombus formation and persistent thrombotic occlusion results in acute myocardial infarction (MI). This topic will review the evidence that antiplatelet therapy is beneficial in patients with an acute non-ST elevation MI (NSTEMI) or unstable angina and will provide recommendations for its use. Information regarding antiplatelet agents in ST elevation MI and the role of anticoagulant therapy in NSTEMI are discussed separately. (See "Antiplatelet agents in acute ST elevation myocardial infarction" and "Anticoagulant therapy in non-ST elevation acute coronary syndromes".)
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- OUR APPROACH
- CLASSIFICATION OF ANTIPLATELET AGENTS
- ASPIRIN FOR ALL PATIENTS
- P2Y12 INHIBITORS FOR ALL PATIENTS
- INVASIVE MANAGEMENT
- GP IIb/IIIa inhibitors
- ISCHEMIA-GUIDED MANAGEMENT
- EARLY CABG
- SPECIFICS OF P2Y12 THERAPY
- Method of administration
- Switching from a P2Y12 agent to clopidogrel
- Bleeding risk
- Resistance/nonresponse to clopidogrel
- SPECIFICS OF GP IIb/IIIa INHIBITOR USE
- LABORATORY TESTING
- PATIENTS PRESENTING ON CLOPIDOGREL
- PATIENTS TAKING ORAL ANTICOAGULANTS
- RECOMMENDATIONS OF OTHERS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS
- Invasive approach
- Ischemia-guided approach