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Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Physician Leads National Guideline Updates for Unstable Angina and Heart Attack

July 17, 2012

HOUSTON - An important update to the U.S. national guidelines concerning the treatment of patients suffering from unstable angina (chest pain) or a common form of heart attack (called non-ST-elevation myocardial infarction) was released yesterday by the joint task force on Practice Guidelines of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA).     

Hani Jneid, M.D., an interventional cardiologist at the Michael E DeBakey VA Medical Center, is the chair of the Writing Group and the lead author of the 2012 ACCF/AHA Guidelines update.

“Since the last update a year ago, the main addition is that medical professionals should consider Ticagrelor, an antiplatelet (blood-thinning) drug, as a treatment option in addition to other blood thinners already being used,” said Jneid, who is also assistant professor of medicine and director of interventional cardiology research at Baylor College of Medicine.

While Ticagrelor, approved by the FDA in 2011, does have benefits (anti-clotting action) and risks (bleeding), Jneid said it is on equal footing with other blood-thinning drugs already in use, in particular, Clopidogrel and Prasugrel.

The panel continues to recommend all patients receive aspirin immediately after hospitalization, continuing as long as it is tolerated. Among the other new recommendations:

  • Patients unable to take aspirin may receive Prasugrel for artery-opening procedures since research on the medication is restricted to those patients. Ticagrelor or Clopidogrel may be given whether patients receive medical therapy alone or are also having an invasive procedure.
  • All patients undergoing invasive procedures should receive both aspirin and another antiplatelet medication.
  • Patients undergoing medical treatment only should receive aspirin indefinitely and Clopidogrel or Ticagrelor for up to or at least 12 months.
  • Ticagrelor should be withheld for five days before elective open heart surgery.
  • The dose of aspirin that should be used with Ticagrelor is 81 mg (baby aspirin).

Unstable angina occurs when the heart muscle does not get enough blood flow and oxygen because a coronary artery is partially blocked. In NSTEMI, there are also abnormal heart enzymes, indicating that some damage to heart muscle is already occurring.

Co-authors of the 2012 ACCF/AHA Guidelines include Jeffrey L. Anderson, M.D., F.A.C.C., F.A.H.A.; R. Scott Wright, M.D., F.A.C.C., F.A.H.A.; Cynthia D. Adams, R.N., Ph.D., F.A.H.A.; Charles R. Bridges, M.D., Sc.D., F.A.C.C., F.A.H.A.; Donald E. Casey, Jr., M.D., M.P.H., M.B.A., F.A.C.P., F.A.H.A.; Steven M. Ettinger, M.D., F.A.C.C.; Francis M. Fesmire, M.D., F.A.C.E.P.; Theodore G. Ganiats, M.D.; A. Michael Lincoff, M.D., F.A.C.C.; Eric D. Peterson, M.D., M.P.H., F.A.C.C., F.A.H.A.; George J. Philippides, M.D., F.A.C.C., F.A.H.A.; Pierre Theroux, M.D., FA.C.C., F.A.H.A.; Nanette K. Wenger, M.D., M.A.C.C., F.A.H.A.; and James Patrick Zidar, M.D., F.A.C.C., F.S.C.A.I.

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