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

ACC, Haymarket Medical Education, HME, myCME, RightSTEPS initiative, prescribing behavior, chronic heart failure
News | Heart Failure| February 22, 2017
The American College of Cardiology (ACC), Haymarket Medical Education (HME) and myCME have joined forces to develop...
coordinated heart attack care, Ontario STEMI Bypass Protocol, Canada
News | Cath Lab| February 22, 2017
Two new Ontario-wide heart attack protocols for paramedic services and emergency departments that aim to saves lives...
transradial approach, same-day cardiac procedures, radial access, $300 million annual savings, JACC Cardiovascular Interventions study
News | Radial Access| February 22, 2017
If hospitals can perform more transradial, same-day percutaneous coronary intervention (PCI), hospitals across the U.S...
Technology | Radial Access| February 17, 2017
Medtronic plc announced that its coronary portfolio will now include the DxTerity Diagnostic Angiography Catheter line...
Sponsored Content | Videos | Inventory Management| February 17, 2017
The supplies you use in your cath lab are complex and very valuable.
Mercator MedSystems, DANCE trial data, ISET, LINC, Bullfrog Micro-Infusion Device
News | Peripheral Arterial Disease (PAD)| February 15, 2017
Mercator MedSystems announced that the national co-principal investigators of the company’s DANCE trial each presented...
Cardinal Health survey, hospital staff, supply chain management, quality of care
News | Inventory Management| February 15, 2017
Better hospital supply chain management leads to better quality of care and supports patient safety, according to a new...
University of Alabama at Birmingham, Amplatzer PFO Occluder, first implementation
News | Structural Heart Occluders| February 15, 2017
Doctors at the University of Alabama at Birmingham have implemented the first U.S. Food and Drug Administration (FDA)-...
Biotronik, PRO-Kinetic Energy cobalt chromium coronary stent system, FDA approval
Technology | Stents Bare Metal| February 15, 2017
The PRO-Kinetic Energy Cobalt Chromium (CoCr) Coronary Stent System from Biotronik has gained U.S. Food and Drug...
heart team, hybird OR, structural heart team

The heart team approach was first used on a large scale in the CoreValve and Sapien TAVR trials and helped lead to excellent outcomes in high-risk patients.

Feature | Hybrid OR| February 15, 2017 | Dave Fornell
In the current era of healthcare reform and the push toward evidence-based medicine to both lower costs and improve p
Overlay Init