cardiovascular disorders
Drugs for Acute Coronary Syndromes
Antiplatelet Drugs
 reduces short- and long-term mortality risk ( Antiplatelet drug references ). Ifaspirincannot be taken,clopidogrel75 mg orally once a day orticlopidine250 mg orally twice a day may be used.Clopidogrelhas largely replacedticlopidinefor routine use because neutropenia is a risk withticlopidineand the white blood cell count must be monitored regularly. Patients with Overview of Acute Coronary Syndromes (ACS) (ACS) in whom intervention is not possible or recommended are given both In patients undergoing Revascularization for Acute Coronary Syndromes , a loading dose of Some clinicians give a GP IIb/IIIa inhibitor during PCI to all high-risk patients (eg, those with markedly elevated cardiac markers, a TIMI risk score≥4, or persistent symptoms despite adequate drug therapy) with large thrombus burden. The GP IIb/IIIa inhibitor is continued for 6 to 24 hours, and angiography is done before the infusion period is over. GP IIb/IIIa inhibitors are not recommended for patients receiving fibrinolytics.Abciximab,tirofiban, andeptifibatideappear to have equivalent efficacy, and the choice of drug should depend on other factors (eg, cost, availability, familiarity). For patients receiving a stent for revascularization,aspirinis continued indefinitely.Clopidogrel75 mg orally once a day,prasugrel10 mg orally once a day, orticagrelor90 mg orally twice a day should be used for at least 1 month in patients with a bare-metal stent. Patients with a drug-eluting stent after ACS have a prolonged risk of thrombosis and benefit from at least 12 months ofclopidogrel(orprasugrelorticagrelor) treatment. 1.Levine GN, Bates ER, Bittl JA, et al: 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery.J Am Coll Cardiol68 (10): 1082–115, 2016. 2.Lawton JS, Tamis-Holland JE, Bangalore S, et al: 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the ACC/AHA Joint Committee on Clinical Practice Guidelines.J Am Coll Cardiol79(2):e21–e129, 2022. doi: 10.1016/j.jacc.2021.09.006 