PLAVIX in Treatment Guidelines
CPR/ECC Guidelines

AHA Guidelines for Emergency Care of acute coronary syndrome (ACS) Recommend PLAVIX as Part of Adjunctive Therapy 19

AHA Guidelines for Emergency Care of Acute Coronary Syndrome (ACS) chart

CPR/ECC Guidelines

CPR/ECC Guidelines for Emergency Care for acute coronary syndrome (ACS), suspected ACS, and STEMI patients (table)

In patients taking clopidogrel bisulfate in whom elective coronary artery bypass graft (CABG) is planned, the drug should be withheld for 5 to 7 days.

A 300 mg loading dose was used in the CLARITY trial, which supports in part the STEMI indication.

‡ With elevated cardiac markers or new ECG changes consistent with ischemia (excluding STEMI) in whom a medical approach or PCI is planned.

§ Without ECG or cardiac marker changes who are unable to take aspirin because of hypersensitivity or major gastrointestinal intolerance.

|| Patients up to 75 years of age who receive aspirin, heparin, and fibrinolysis.

Please refer to the full text of each guideline for all recommendations and sequencing of therapies.

*ACC/AHA=American College of Cardiology/American Heart Association.

† Click here to see the complete text of the 00 ACC/AHA UA and NSTEMI recommendations regarding PLAVIX and the definitions for ACC/AHA classifications and Levels of Evidence.

Indications
–
Use PLAVIX plus aspirin for patients with non–ST–segment elevation acute coronary syndrome (UA/non–Q–wave MI), including patients to be managed medically and those to be managed with percutaneous coronary intervention (with or without stent) or CABG, to decrease the rate of a combined end point of CV death, MI, or stroke as well as the rate of a combined end point of CV death, MI, stroke, or refractory ischemia.

–
Use PLAVIX plus aspirin for patients with ST–segment elevation acute myocardial infarction to reduce the rate of death from any cause and the rate of a combined end point of death, reinfarction, or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.

–
Use PLAVIX alone for patients with a history of recent stroke, recent MI, or established PAD to reduce the rate of a combined end point of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
Important Risk Information 18
–
PLAVIX is contraindicated in patients with active pathologic bleeding such as peptic ulcer or intracranial hemorrhage. PLAVIX should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or coadministration with NSAIDs or warfarin. (See CONTRAINDICATIONS and PRECAUTIONS.*)

–
The rates of major and minor bleeding were higher in patients treated with PLAVIX plus aspirin compared with placebo
plus aspirin in clinical trials. (See ADVERSE REACTIONS.*)

–
Due to an expected reduction in drug levels and clinical efficacy, concomitant use of drugs that inhibit CYP2C19 (eg, omeprazole) should be discouraged. (See PRECAUTIONS.*)

–
As part of the worldwide post–marketing experience with PLAVIX, there have been cases of reported thrombotic thrombocytopenic purpura (TTP), some with fatal outcome. TTP has been reported rarely following use of PLAVIX, sometimes after a short exposure (<2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment including plasmapheresis (plasma exchange). (See WARNINGS.*)

–
Based on literature, patients with genetically reduced CYP2C19 function have diminished responses and generally exhibit higher CV event rates following MI. (See PRECAUTIONS.*)

–
In clinical trials, the most common clinically important side effects were pruritus, purpura, diarrhea, and rash; infrequent events included intracranial hemorrhage (0.4%) and severe neutropenia (0.05%). (See ADVERSE REACTIONS.*)