Oral Antiplatelet Therapy in Unstable Angina/Non-ST-Segment Elevation Myocardial Infarction, ST-Segment Elevation Myocardial Infarction, and Percutaneous Coronary Intervention: Is it Time for a Guideline Update?

Oral antiplatelet drugs are central in the management of acute coronary syndromes, including unstable angina/non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction, and percutaneous coronary intervention. However, the mechanisms that confer the benefits of these agents also increase bleeding risk. Thus, the selection of appropriate pharmacotherapy requires close attention to the delicate balance between reducing the risk of ischemic events and minimizing bleeding risk. A critical review of the 2007 guidelines in these areas and new clinical data with currently available and soon-to-be-approved antiplatelet agents are presented.