Feature | July 20, 2012

Updated AHA/ACCF Guidelines for Unstable Angina Include Newest Blood Thinning Drug

July 20, 2012 — Ticagrelor (Brilinta), a blood-thinning drug approved by the U.S. Food and Drug Administration (FDA) in 2011, should be considered along with older blood thinners clopidogrel (Plavix) and prasugrel (Effient) for treating patients who are experiencing chest pain or some heart attacks, according to joint updated guidelines issued by the American Heart Association (AHA) Task Force on Practice Guidelines and the American College of Cardiology (ACCF) Foundation.

The “focused update” on unstable angina (chest pain) or non-ST-elevation myocardial infarction (NSTEMI) is published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.

The panel continues to recommend that all patients receive aspirin immediately after hospitalization, continuing as long as it is tolerated. Among the other new recommendations:

  • Patients unable to take aspirin may receive prasugrel for artery-opening procedures since research on the medication is restricted to those patients. Ticagrelor or clopidogrel may be given whether patients receive medical therapy alone or are also having an invasive procedure;
  • Patients undergoing invasive procedures should receive both aspirin and another antiplatelet medication; and
  • Patients undergoing medical treatment only should receive aspirin indefinitely and clopidogrel or ticagrelor for up to or at least 12 months.


The AHA and ACCF issue focused updates when pivotal new data are reported that may affect changes to current recommendations and meet specific criteria. One year after the last update, the biggest change is the recommendation to consider ticagrelor as a treatment option in addition to clopidogrel and prasugrel. The panel’s report highlights both the benefits (anti-clotting action) and risks (bleeding) of the new drug.

“We have put it on equal footing with two other antiplatelet medications, clopidogrel and prasugrel,” said Hani Jneid, M.D., lead author of the update and an assistant professor of medicine and director of interventional cardiology research at Baylor College of Medicine, and an interventional cardiologist at the Michael E. DeBakey VA Medical Center in Houston.

Unstable angina occurs when the heart muscle doesn’t get enough blood flow and oxygen because a coronary artery is partially blocked. In NSTEMI, there are also abnormal heart enzymes, indicating that some damage to heart muscle is already occurring.

“These conditions are very common and carry a high risk of death and recurrent heart attacks,” Jneid said. “The AHA and ACCF constantly update their guidelines so that physicians can provide patients with the most appropriate, aggressive therapy with the goal of improving health and survival.”

To continue to improve the treatment of these important conditions, the panel encourages clinicians and hospitals to participate in a quality of care data registry designed to track and measure outcomes, complications and adherence to evidence-based recommendations.

“While this focused update of the guidelines provides important guidance to clinicians, our recommendations are not substitutes for a physician’s own clinical judgments and the tailoring of therapy based on individual variability and a patient’s presentation and clinical diagnosis,” Jneid said.

For more information: www.heart.org, www.cardiosource.org/ACC 

Related Content

Mitralign, Percutaneous Tricuspid Valve Annuloplasty System

Mitralign's Percutaneous Tricuspid Valve Annuloplasty System uses catheter delivered pledgeted sutures that can be cinched together to change the valve annulus geometry to help eliminate valvular regurgitation. 

News | Heart Valve Repair| August 31, 2015
August 31, 2015 — Mitralign Inc. said the U.S.
biomimics, 3D stent
News | Peripheral Arterial Disease (PAD)| August 28, 2015
August 28, 2015 — PinnacleHealth CardioVascular Institute enrolled the first patient in Pennsylvania and second in th
iFR, FFR, Philips, Volcano
News | Cath Lab| August 28, 2015
August 28, 2015 — Philips Healthcare is showcasing its latest cardiology solutions at the European Society of Cardiol
News | Heart Failure| August 28, 2015
August 28, 2015 — BioControl Medical said it has completed enrollment in its INOVATE-HF (INcrease Of VAgal TonE in He
Stent graft, computational fluid dynamics, CFD, stent engineering

In this vector velocity model, brighter colors indicate blood flow acceleration as it passes through a bifurcation. Computation fluid dynamic modeling provides insight on blood flow through and near the walls of the stent graft. Image courtesy of Sanford Health

News | Cath Lab| August 27, 2015
August 27, 2015 — The use of computational fluid dynamics (CFD) modeling has been used for years to better engineer l
News | Cath Lab| August 26, 2015
August 26, 2014 — The Cardiovascular Research Foundation (CRF) announced the late-breaking trials and first report in

Mitral regurgitation viewed under color Doppler. Image courtesy of Toshiba.

Feature | Heart Valve Repair| August 26, 2015
August 25, 2015 — Medtronic announced it entered a definitive agreement to acquire Twelve Inc., a start–up medical de
NuCART, CompView Medical, mobile boom system, cath lab, hybrid OR
Technology | Cath Lab| August 21, 2015
August 21, 2015 — CompView Medical announced the release of the NuCART, a turn-key, all-in-one mobile boom system wit
Corindus, Corpath, radiation dose monitoring, cath lab, vascular robotic system

The Corindus Corpath vascular robotic system.

Technology | Radiation Dose Management| August 19, 2015
Corindus Vascular Robotics Inc. and Unfors RaySafe Inc., a Fluke Biomedical Company, announced a distribution agreement...
Sunshine Heart, COUNTER HF pivotal study, resumes enrollment, C-Pulse, FDA
News | Heart Failure| August 18, 2015
Sunshine Heart Inc. announced an update in late July on its COUNTER HF U.S. pivotal study for the C-Pulse Heart Assist...
Overlay Init