title: Oral antiplatelet agents for the management of acute coronary syndromes: A review for nurses and allied healthcare professionals.
abstract: OBJECTIVE
  We review the use of oral antiplatelet (OAP) therapies in acute coronary syndrome (ACS) management for nurse practitioners (NPs), focusing on current guideline recommendations.
  
  
  METHODS
  Treatment guidelines and clinical articles from PubMed.
  
  
  CONCLUSIONS
  Guidelines recommend that dual antiplatelet therapy with a P2Y12inhibitor and aspirin be initiated for ACS management. The P2Y12inhibitor clopidogrel has established efficacy, but is associated with suboptimal and delayed platelet inhibition and variability in response. The newer P2Y12inhibitors prasugrel and ticagrelor have demonstrated superior efficacy outcomes versus clopidogrel. Consequently, non-ST-segment elevation ACS (NSTE-ACS) guidelines now recommend that ticagrelor be used in preference to clopidogrel for patients treated with stents or managed medically. Because of their higher potency, prasugrel and ticagrelor are associated with increased bleeding rates versus clopidogrel, but with no increased risk of severe or life-threatening bleeding. Guidelines recommend dual antiplatelet therapy be continued ≥12 months in both medically managed and stented ACS patients, and in some cases beyond this, in absence of high bleeding risk. Updated guidelines assign preference to ticagrelor over clopidogrel for maintenance therapy in patients with NSTE-ACS and ST-elevation myocardial infarction.
  
  
  CONCLUSIONS
  Enhanced NP understanding of OAP agents and current guidelines could contribute to improved ACS patient management.
authors.affiliation: Kaufman Cancer Center, University of Maryland, Bel Air, Maryland.
authors.forename: Tania
authors.initials: T
authors.lastname: Gesheff
authors.affiliation: Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia.
authors.forename: Cescelle
authors.initials: C
authors.lastname: Barbour
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000284:Administration, Oral; D001190:Arylsulfonates / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D019468:Disease Management; D006801:Humans; D009722:Nurse Practitioners; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D001190:Arylsulfonates; D010975:Platelet Aggregation Inhibitors; C050296:metsulfuron methyl; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: Cardiovascular diseases; acute coronary syndrome; nurse practitioners; pharmacologic action