PLAVIX in Treatment Guidelines
ACC/AHA UA/NSTEMI Guidelines

UA/NSTEMI Guidelines

Multiple treatment guidelines include recommendations for PLAVIX. The ACC/AHA 2002 Guideline Update include PLAVIX recommendations for acute coronary syndrome (ACS).

ACC/AHA UA/NSTEMI Guidelines and Recommendations per Atherothrombotic Patient Type (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.

As reported by CRUSADE, guideline-recommended therapies are underutilized for UA/NSTEMI patients 18

  • 59% of patients received PLAVIX during the first 24 hours of hospitalization
  • 53% of medically managed patients received PLAVIX at discharge vs 97% of those who underwent percutaneous coronary intervention (PCI) 18

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

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

¶ CRUSADE=Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines is a national quality improvement initiative for UA/NSTEMI patients. Duke Clinical Research Institute; CRUSADE is funded by Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership.

Indications
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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.

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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.

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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
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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.*)

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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.*)

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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.*)

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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.*)

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

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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.*)