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Antithrombotic Therapy for Coronary Artery Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Robert A. Harrington, Richard C. Becker, Michael Ezekowitz, Thomas W. Meade, Christopher M. O’Connor, David A. Vorchheimer and Gordon H. Guyatt Chest 2004;126;513-548 DOI 10.1378/chest.126.3_suppl.513S

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Antithrombotic Therapy for Coronary Artery Disease
The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Robert A.Harrington, MD; Richard C. Becker, MD, FCCP; Michael Ezekowitz, MD; Thomas W. Meade, DM, FCCP; Christopher M. O’Connor, MD; David A. Vorchheimer, MD; and Gordon H. Guyatt, MD, FCCP

This chapter about antithrombotic therapy for coronary artery disease (CAD) is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations arestrong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients’ values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S–187S). Among the key recommendations in this chapter are the following: For patients presenting with non–ST-segment elevation (NSTE) acute coronarysyndrome (ACS), we recommend immediate and then daily oral aspirin (Grade 1A). For patients with an aspirin allergy, we recommend immediate treatment with clopidogrel, 300-mg bolus po, followed by 75 mg/d indefinitely (Grade 1A). In all NSTE ACS patients in whom diagnostic catheterization will be delayed or when coronary bypass surgery will not occur until > 5 days, we recommend clopidogrel as bolustherapy (300 mg), followed by 75 mg/d for 9 to 12 months in addition to aspirin (Grade 1A). In NSTE ACS patients in whom angiography will take place within 24 h, we suggest beginning clopidogrel after the coronary anatomy has been determined (Grade 2A). For patients who have received clopidogrel and are scheduled for coronary bypass surgery, we recommend discontinuing clopidogrel for 5 days prior tothe scheduled surgery (Grade 2A). In moderate- to high-risk patients presenting with NSTE ACS, we recommend either eptifibatide or tirofiban for initial (early) treatment in addition to treatment with aspirin and heparin (Grade 1A). For the acute treatment of NSTE ACS, we recommend low molecular weight heparins over unfractionated heparin (UFH) [Grade 1B] and UFH over no heparin therapy use withantiplatelet therapies (Grade 1A). We recommend against the direct thrombin inhibitors as routine initial antithrombin therapy (Grade 1B). For patients after myocardial infarction, after ACS, and with stable CAD, we
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: permissions@chestnet.org). Correspondence to: Robert A.Harrington, MD, Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705; e-mail: Harri019@dcri.duke.edu
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recommend aspirin in doses from 75 to 325 mg as initial therapy and in doses of 75 to 162 mg as indefinite therapy (Grade 1A). For patients with contraindications to aspirin, we recommend longterm clopidogrel (Grade 1A). For primary prevention in patients with...