PMID- 27027367
OWN - NLM
STAT- MEDLINE
DCOM- 20161017
LR  - 20181202
IS  - 1678-4170 (Electronic)
IS  - 0066-782X (Print)
IS  - 0066-782X (Linking)
VI  - 106
IP  - 3
DP  - 2016 Mar
TI  - When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute 
      Coronary Syndrome?
PG  - 236-46
LID - S0066-782X2016000300236 [pii]
LID - 10.5935/abc.20160042 [doi]
AB  - Dual antiplatelet therapy is a well-established treatment in patients with non-ST 
      elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation 
      (level of evidence A) in current national and international guidelines. 
      Nonetheless, these guidelines are not precise or consensual regarding the best 
      time to start the second antiplatelet agent. The evidences are conflicting, and 
      after more than a decade using clopidogrel in this scenario, benefits from the 
      routine pretreatment, i.e. without knowing the coronary anatomy, with dual 
      antiplatelet therapy remain uncertain. The recommendation for the upfront 
      treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal 
      events in studies that used the conservative strategy with eventual invasive 
      stratification, after many days of the acute event. This approach is different 
      from the current management of these patients, considering the established 
      benefits from the early invasive strategy, especially in moderate to high-risk 
      patients. The only randomized study to date that specifically tested the 
      pretreatment in NSTE-ACS in the context of early invasive strategy, used 
      prasugrel, and it did not show any benefit in reducing ischemic events with 
      pretreatment. On the contrary, its administration increased the risk of bleeding 
      events. This study has brought the pretreatment again into discussion, and led to 
      changes in recent guidelines of the American and European cardiology societies. 
      In this paper, the authors review the main evidence of the pretreatment with dual 
      antiplatelet therapy in NSTE-ACS.
FAU - de Barros e Silva, Pedro Gabriel Melo
AU  - de Barros e Silva PG
AD  - Hospital TotalCor, Sao Paulo, SP, Brazil.
FAU - Ribeiro, Henrique Barbosa
AU  - Ribeiro HB
AD  - Hospital TotalCor, Sao Paulo, SP, Brazil.
FAU - Baruzzi, Antonio Claudio do Amaral
AU  - Baruzzi AC
AD  - Hospital TotalCor, Sao Paulo, SP, Brazil.
FAU - da Silva, Expedito Eustaquio Ribeiro
AU  - da Silva EE
AD  - Hospital TotalCor, Sao Paulo, SP, Brazil.
LA  - eng
LA  - por
PT  - Journal Article
PT  - Review
PL  - Brazil
TA  - Arq Bras Cardiol
JT  - Arquivos brasileiros de cardiologia
JID - 0421031
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Clinical Trials as Topic
MH  - Clopidogrel
MH  - Humans
MH  - Meta-Analysis as Topic
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Practice Guidelines as Topic
MH  - Premedication/*methods
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Time Factors
PMC - PMC4811279
COIS- Potential Conflict of Interest Expedito Eustaquio Ribeiro da Silva, MD, is a 
      lecturer for Daiichi Sankyo.
EDAT- 2016/03/31 06:00
MHDA- 2016/10/19 06:00
PMCR- 2016/03/01
CRDT- 2016/03/31 06:00
PHST- 2015/04/28 00:00 [received]
PHST- 2015/11/17 00:00 [accepted]
PHST- 2016/03/31 06:00 [entrez]
PHST- 2016/03/31 06:00 [pubmed]
PHST- 2016/10/19 06:00 [medline]
PHST- 2016/03/01 00:00 [pmc-release]
AID - S0066-782X2016000300236 [pii]
AID - 10.5935/abc.20160042 [doi]
PST - ppublish
SO  - Arq Bras Cardiol. 2016 Mar;106(3):236-46. doi: 10.5935/abc.20160042.