Understanding and Treating Acute Coronary Syndrome - FreeCE

Page 8Understanding and Treating Acute Coronary Syndrome© 2010 Pharmaceutical Education Consultants, Inc. unless otherwise noted. All rights reserved.Reproduction in whole or in part without permission is prohibited.November 18, 2009Expert Consensus Statement• Dual antiplatelet therapy not routinely recommendedfor patients with prior ischemic stroke• Patients with prior GI bleed are at highest risk• Consider other factors: age, concurrent use ofanticoagulants or NSAIDS, and H pylori infection• PPIs are recommended for patients with a hx of upperGI bleed and may be appropriate for patients withmultiple risk factors• PPIs and H2 antagonists are not recommended forroutine use in patients at low risk29J Am Coll Cardiology, published online 11/8/1030Patient Case POLL QUESTIONPMH: GERD and dyslipidemia. Medications: omeprazole 20mg qd, atorvastatin 40 mg qd.He receives a drug eluting stent and requires dual antiplatelettherapy. Aspirin and clopidogrel were added to his regimen.What would you do?a. Discontinue omeprazole, add ranitidineb. Discontinue clopidogrel, add prasugrelc. Assess platelet reactivity with VerifyNow Assayd. Recommend genetic testingPrasugrel (Effient ® )• Thienopyridine approved July 2009• Indicated in ACS managed with PCI• Contraindicated in patients with a previous TIA or stroke• Not used in elective PCI• Benefit in patients > 75 years or < 60 kg has not beenproven (May give a lower dose (5 mg) for patients