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Thienopyridines

IIa. IIa. IIa. IIa. IIb. IIb. IIb. IIb. III. III. III. III. I. I. I. IIa. IIa. IIa. IIa. IIb. IIb. IIb. IIb. III. III. III. III. I. I. I. IIa. IIa. IIa. IIa. IIb. IIb. IIb. IIb. III. III. III. III. I. I. I. A. Thienopyridines.

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Thienopyridines

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  1. IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I A Thienopyridines Clopidogrel 75 mg per day orally should be added to aspirin in patients with STEMI regardless of whether they undergo reperfusion with fibrinolytic therapy or do not receive reperfusion therapy.

  2. IIa IIa IIa IIa IIa IIa IIa IIa IIb IIb IIb IIb IIb IIb IIb IIb III III III III III III III III I I I I I I IIa IIa IIa IIa IIa IIa IIa IIa IIb IIb IIb IIb IIb IIb IIb IIb III III III III III III III III I I I I I I IIa IIa IIa IIa IIa IIa IIa IIa IIb IIb IIb IIb IIb IIb IIb IIb III III III III III III III III I I I I I I C C Thienopyridines In patients < 75 years who receive fibrinolytic therapy or who do not receive reperfusion therapy, it is reasonable to administer an oral clopidogrel loading dose of 300 mg. (No data are available to guide decision making regarding an oral loading dose in patients ≥ 75 years of age.) Long-term maintenance therapy (e.g., 1 year) with clopidogrel (75 mg per day orally) can be useful in STEMI patients regardless of whether they undergo reperfusion with fibrinolytic therapy or do not receive reperfusion therapy.

  3. Antiplatelet Therapy For UA/NSTEMI patients treated medically without stenting, aspirin* (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 (Level of Evidence: A) and ideally for up to 1 year. (Level of Evidence: B) I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III See recommendation for LOE *For ASA-allergic patients, use clopidogrel alone (indefinitely), or try aspirin desensitization. †For clopidogrel-allergic patients, use ticlopidine 250 mg by mouth twice daily.

  4. GP IIb-IIIa: the Final Common Pathway to Platelet Aggregation White HD. Am J Cardiol. 1997; 80(4A):2B-10B.

  5. Benefit of GP IIb IIIa inhibition among patients with USAP/NSTEMI treated with PCI across all large trails Braunwald E. et al. ACC/AHA Guidelines. JACC 2000;36:970-1062

  6. IIb-IIIa Inhibition for NSTEMI

  7. PRISM,PRISM-Plus,PARAGON A & B,PURSUIT,GUSTO-IV Roffi et al. Circ 2001;104:2767-71

  8. Appropriate use of GP IIb IIIa inhibitorsWho may benefit the most? Troponin positive. DM. ACS undergoing PCI. Dynamic ST changes?. Angina refractory to standard medical therapy?.

  9. Anti-Thrombotics

  10. AT IIa Hep UFH

  11. ASA and UFH vs ASA alone Meta-analysis of six randomized trails Oler A et al. JAMA 1996;276:811-815

  12. Unfractionated Heparin Advantages Disadvantages • Immediate anticoagulation • Multiple sites of action in coagulation cascade • Long history of successful clinical use • Readily monitored by aPTT and ACT • Indirect thrombin inhibitor so does not inhibit clot-bound thrombin • Nonspecific bindAingto: • Serine AAofHIT Hirsh J, et al. Circulation. 2001;103:2994-3018. aPTT = activated partial thromboplastin time; ACT = activated coagulation time; PF-4 = platelet factor 4; HIT = heparin-induced thrombocytopenia.

  13. AT IIa Hep UFH AT Xa LMWH

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