Table 2.
Summary of changes in the guidelines' recommendations through the time
| Cardiology society | Year | Recommendation of pretreatment |
|---|---|---|
| American Cardiology of Cardiology/ American Heart Association | 200738 | The pretreatment is recommended, although the guideline also present the following sentence: "initiation of clopidogrel may be deferred until a revascularization decision is made" |
| 201241 | Patients diagnosed with moderate or high-risk NSTE-ACS should receive dual antiplatelet therapy (pre-catheterization) | |
| 201412 | There is no clear recommendation for DAPT before knowing the coronary anatomy. It recommends a loading with P2Y12 inhibitor in patients who will undergoing PCI with stenting | |
| 200739 | "Postponing clopidogrel to after angiography cannot be recommended" | |
| 201040 | ||
| 201143 | A P2Y12 inhibitor should be used as soon as possible | |
| European Society of Cardiology | 201444 | Pretreatment with prasugrel in patients in whom coronary anatomy is not known: class of recommendation III, level of evidence B* |
| 201513 | There is a specific session to discuss the best moment for P2Y12 administration, which highlights the controversy of the subject. Since there is no appropriate investigation on clopidogrel and ticagrelor, the guidelines do not specify any recommendation (in favor or against) on pretreatment in early invasive strategy, and do not recommend pretreatment with prasugrel. In conservative approach, P2Y12 inhibitor should be initiated (preferentially ticagrelor) as soon as the diagnosis is confirmed. | |
| Sociedade Brasileira de Cardiologia | 201337 | In both, there is no formal recommendation about the best moment for the second antiplatelet agent, and prasugrel is recommended only after the coronary anatomy is known |
| 201442 |
*
With respect to clopidogrel and ticagrelor in NSTE-ACS, these guidelines do not make any specific recommendation, but bring a discussion about related evidence, and reinforce that the pretreatment with ticagrelor had not been tested yet. NSTE-ACS: non-ST-segment-elevation acute coronary syndrome; DAPT: dual antiplatelet therapy; PCI: percutaneous coronary intervention.