Antiplatelet therapy for initial management of non-ST-elevation acute coronary syndrome

CABG: coronary artery bypass graft surgery; CAD: coronary artery disease; CCTA: coronary computed tomographic angiography; NSTEACS: non-ST-elevation acute coronary syndrome; PCI: percutaneous coronary intervention; TIA: transient ischemic attack.

* For information on dosing, refer to UpToDate topics on antiplatelet therapy in NSTEACS.

¶ An invasive strategy involves proceeding to diagnostic angiography without prior stress testing or anatomic imaging (eg, CCTA) for obstructive CAD, while a noninvasive strategy involves stress imaging or CCTA for obstructive CAD and angiography only upon identification of evidence of obstructive CAD.

Δ In NSTEACS, the PCI procedure is typically performed immediately after diagnostic angiography. If for any reason (eg, effects of sedation), a P2Y₁₂ inhibitor cannot be administered immediately prior to PCI, it is reasonable to give the first dose of P2Y₁₂ inhibitor as soon as the patient can take oral medications.

◊ For more information on antiplatelet therapy prior to CABG, refer to UpToDate topics on antiplatelet therapy in acute coronary syndromes.