Managing the acute coronary syndrome patient: Evidence based recommendations for anti-platelet therapy

Abstract

Acute coronary syndrome (ACS) is best managed by a multidisciplinary team in which primary care physicians, physician assistants, nurse practitioners, and pharmacists play a key role. This article summarizes recent updates to American College of Cardiology Foundation/American Heart Association guidelines for the management of unstable angina (UA)/non ST-segment elevation ACS (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), focusing on antiplatelet therapy. Dual antiplatelet therapy comprising aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is recommended for patients with NSTE-ACS, and those with STEMI both during and after reperfusion. The guidelines provide recommendations regarding the utilization of P2Y12 inhibitors in specific circumstances and are discussed in this review. Health care teams with a key role in post-ACS care need to be familiar with the latest guidelines and support patients with education on risk reduction and the benefits of long-term medication adherence.

Keywords: Acute coronary syndrome; Clopidogrel; Myocardial infarction; Prasugrel; Ticagrelor; Unstable angina.