Evidence-based Antiplatelet Pretreatment in Non-ST-elevation Acute Coronary Syndromes

Antiplatelet pretreatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) is controversial. It is vital that the risk of ischaemia and the risk of haemorrhage are both considered when managing this patient group. Current clinical guidelines do not recommend routine pretreatment in patients presenting with NSTE-ACS who are having coronary angiography within 24 hours. However, a significant portion of these patients will not have coronary angiography until after 24 hours. Pretreatment with antiplatelets may reduce the risk of ischaemic events, but it is associated with bleeding and delays to coronary artery bypass grafting, and it may be deleterious in patients with diagnoses other than NSTE-ACS, such as acute aortic syndromes, pulmonary embolism or intracranial bleeds. This review analyses the most important studies assessing antiplatelet pretreatment in NSTE-ACS.