PMID- 15383483
OWN - NLM
STAT- MEDLINE
DCOM- 20041026
LR  - 20181130
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 126
IP  - 3 Suppl
DP  - 2004 Sep
TI  - Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference 
      on Antithrombotic and Thrombolytic Therapy.
PG  - 513S-548S
AB  - This chapter about antithrombotic therapy for coronary artery disease (CAD) is 
      part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: 
      Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that 
      the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests 
      that individual patients' values may lead to different choices (for a full 
      understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among 
      the key recommendations in this chapter are the following: For patients 
      presenting with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS), we 
      recommend immediate and then daily oral aspirin (Grade 1A). For patients with an 
      aspirin allergy, we recommend immediate treatment with clopidogrel, 300-mg bolus 
      po, followed by 75 mg/d indefinitely (Grade 1A). In all NSTE ACS patients in whom 
      diagnostic catheterization will be delayed or when coronary bypass surgery will 
      not occur until > 5 days, we recommend clopidogrel as bolus therapy (300 mg), 
      followed by 75 mg/d for 9 to 12 months in addition to aspirin (Grade 1A). In NSTE 
      ACS patients in whom angiography will take place within 24 h, we suggest 
      beginning clopidogrel after the coronary anatomy has been determined (Grade 2A). 
      For patients who have received clopidogrel and are scheduled for coronary bypass 
      surgery, we recommend discontinuing clopidogrel for 5 days prior to the scheduled 
      surgery (Grade 2A). In moderate- to high-risk patients presenting with NSTE ACS, 
      we recommend either eptifibatide or tirofiban for initial (early) treatment in 
      addition to treatment with aspirin and heparin (Grade 1A). For the acute 
      treatment of NSTE ACS, we recommend low molecular weight heparins over 
      unfractionated heparin (UFH) [Grade 1B] and UFH over no heparin therapy use with 
      antiplatelet therapies (Grade 1A). We recommend against the direct thrombin 
      inhibitors as routine initial antithrombin therapy (Grade 1B). For patients after 
      myocardial infarction, after ACS, and with stable CAD, we recommend aspirin in 
      doses from 75 to 325 mg as initial therapy and in doses of 75 to 162 mg as 
      indefinite therapy (Grade 1A). For patients with contraindications to aspirin, we 
      recommend long-term clopidogrel (Grade 1A). For primary prevention in patients 
      with at least moderate risk for a coronary event, we recommend aspirin, 75 to 162 
      mg/d, over either no antithrombotic therapy or vitamin K antagonist (VKA) [Grade 
      2A]; for patients at particularly high risk of events in whom the international 
      normalized ratio (INR) can be monitored without difficulty, we suggest low-dose 
      VKA (target INR, 1.5) [Grade 2A].
FAU - Harrington, Robert A
AU  - Harrington RA
AD  - Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705, USA. 
      Harri019@dcri.duke.edu
FAU - Becker, Richard C
AU  - Becker RC
FAU - Ezekowitz, Michael
AU  - Ezekowitz M
FAU - Meade, Thomas W
AU  - Meade TW
FAU - O'Connor, Christopher M
AU  - O'Connor CM
FAU - Vorchheimer, David A
AU  - Vorchheimer DA
FAU - Guyatt, Gordon H
AU  - Guyatt GH
LA  - eng
PT  - Guideline
PT  - Journal Article
PT  - Practice Guideline
PT  - Review
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Antithrombins/adverse effects/therapeutic use
MH  - Aspirin/adverse effects/therapeutic use
MH  - Clopidogrel
MH  - Coronary Angiography
MH  - Coronary Artery Bypass
MH  - Coronary Artery Disease/blood/diagnostic imaging/*drug therapy
MH  - Coronary Thrombosis/blood/diagnostic imaging/*drug therapy
MH  - Electrocardiography/drug effects
MH  - Evidence-Based Medicine
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/blood/diagnostic imaging/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Ticlopidine/adverse effects/*analogs & derivatives/therapeutic use
RF  - 164
EDAT- 2004/09/24 05:00
MHDA- 2004/10/27 09:00
CRDT- 2004/09/24 05:00
PHST- 2004/09/24 05:00 [pubmed]
PHST- 2004/10/27 09:00 [medline]
PHST- 2004/09/24 05:00 [entrez]
AID - S0012-3692(15)31502-6 [pii]
AID - 10.1378/chest.126.3_suppl.513S [doi]
PST - ppublish
SO  - Chest. 2004 Sep;126(3 Suppl):513S-548S. doi: 10.1378/chest.126.3_suppl.513S.