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New ESC Guidelines for non-ST elevation ACS
The largest part of the guideline is devoted to the two most important pillars of NSTE-ACS treatment, pharmacological antithrombotic therapy and revascularisation. Dual antiplatelet treatment (DAPT) consisting of aspirin in combination with a P2Y12 inhibitor is recommended in all patients presenting with ACS. Newer P2Y12 inhibitors (ticagrelor, prasugrel) are preferred over clopidogrel because of improved ischaemic outcomes (COR I, LOE B). However, preloading with prasugrel (prior to coronary angiography) in NSTE-ACS is not recommended based on excess bleeding risks documented in the ACCOAST trial (COR III, LOE B). Cangrelor and vorapaxar have recently received marketing authorisation by the EMA, but the guideline task force thought it premature to make any recommendation based on limited and somewhat controversial published data….
