The ACC/AHA recommendations are classified based on the benefit, risk, and level of evidence, with class I recommendations reflecting the highest benefit-to-risk ratio. The 2007 ACC/AHA class I recommendations for antiplatelet therapy in patients with NSTEMI or UA are listed in Table 1.
Immediate administration of a single 162- to 325-mg dose of non-enteric aspirin and addition of a 300- to 600-mg loading dose of the thienopyridine clopidogrel are recommended for all patients, regardless of whether an invasive or noninvasive strategy is chosen. Clopidogrel may be used instead of aspirin for patients who cannot take aspirin because of hypersensitivity or gastrointestinal (GI) intolerance. Patients with a history of GI bleeding should receive drugs to minimize the risk of recurrent GI bleeding (e.g., proton pump inhibitors) when receiving aspirin, clopidogrel, or both. Clopidogrel should be withheld for at least 5 days before elective CABG.
In patients with NSTEMI or UA for whom a conservative approach is chosen, it may be reasonable to add a platelet glycoprotein (GP) IIb/IIIa inhibitor (eptifibatide or tirofiban) to aspirin and clopidogrel, especially in patients with recurrent ischemic discomfort with clopidogrel, aspirin, and anticoagulants. However, the GP IIb/IIIa inhibitor abciximab should be avoided in these patients.
Guidelines for Antithrombotic Therapy in the Management of Acute Coronary Syndrome and Venous Thromboembolism in Health Systems by American Society of Health-System Pharmacists (ASHP) - http://ashpmedia.org/symposia/cvseries/ACS_DiscGuide_2.pdf
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non_ST-Elevation Myocardial Infarction - http://content.onlinejacc.org/cgi/reprint/50/7/e1.pdf
* ACC = American College of Cardiology; AHA = American Heart Association
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