1. Proposed use of P2Y12 inhibitors
Proposed use of P2Y12 inhibitors. aDo not use clopidogrel in patients with active pathological bleeding; consider alternative P2Y12 receptor inhibitor if documented clopidogrel ineffectiveness (e.g., poor metabolism, stent thrombosis during clopidogrel therapy) or drug–drug interactions (e.g., avoid moderate and strong CYP2C19 inhibitors); clopidogrel should be held for at least 5 days before CABG surgery, if the surgery can be delayed. bDo not use prasugrel in patients with active pathological bleeding or a history of transient ischemic attack or stroke; if a patient subsequently goes on to receive CABG surgery, the drug should be held for at least 7 days if the surgery can be delayed. cDo not use ticagrelor in patients with active pathological bleeding or a history of intracranial hemorrhage, or in patients planned to undergo urgent CABG surgery; concomitant maintenance aspirin dose above 100 mg should be avoided; dose of ticagrelor should be held for 5 days before CABG surgery if the surgery can be delayed; when selecting this agent consider patient compliance (dosed twice daily), unique adverse effects (e.g., dyspnea), and potential drug–drug interactions (e.g., avoid strong CYP3A inhibitors/inducers). dPrior to diagnostic angiography, it is difficult to determine the likelihood that an individual patient will receive CABG surgery; notable variables that predict this occurrence include previous CABG, male gender, previous heart failure, presence of diabetes, previous percutaneous coronary intervention, among others. eRecommendation based on subgroup analysis. fAt this time, there is insufficient data to support ticagrelor or prasugrel in the "fibrinolytic or nonprimary PCI" patient group. (ACS, acute coronary syndrome; CABG, coronary artery bypass surgery; MI, myocardial infarction; NSTE, non-ST-segment elevation; PCI, percutaneous coronary intervention; STE, ST-segment elevation; TIA, transient ischemic attack.) (Adapted from Crouch MA, Colucci VJ, Howard PA, Spinler SA. P2Y12 receptor inhibitors: Integrating ticagrelor into the management of acute coronary syndrome. Ann Pharmacother 2011;45:1151–1156, with permission.)
Source: Acute Coronary Syndromes, Pharmacotherapy Principles & Practice, 3e
Citation: Chisholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, Kolesar JM, DiPiro JT. Pharmacotherapy Principles & Practice, 3e; 2013 Available at: Accessed: November 14, 2017
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