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For instance, whereas in current guidelines, standard antiplatelet therapy includes aspirin 81 mg daily along with either clopidogrel 75 mg daily or ticagrelor 90 mg twice daily for a month or a year depending on whether the patient has or will undergo PCI, who is being treated for an ACS, or PCI to a non-infarct-related artery, the new NICE guidelines recommend coronary anatomy-guided platelet inhibition (PCI or CABG conditioned by the atherosclerotic coronary disease severity) with standard treatment of clopidogrel (75 mg daily) and aspirin (75–100 mg daily) for at least 1 year post-PCI or CABG; they also suggest that alternative antiplatelet agents (prasugrel or ticagrelor) may be used, depending on the results of the patient's antiplatelet testing. In cardiac surgery, however, the NICE guidelines now indicate that aspirin, clopidogrel, prasugrel, or ticagrelor can be administered, as per hospital-specific protocols, unless it is determined that a combination of different antiplatelet agents (all of which extend the half-lives of clopidogrel and ticagrelor) is required for a specific patient. However, presence of an intracardiac shunt or prosthetic valve graft has been shown to significantly reduce the potential inhibition of platelets by clopidogrel, and thus should be avoided .
Multivariate logistic regression analysis was used to identify independent predictors of infarct pattern at first presentation. Independent predictors were then incorporated into the model as time-related variables to generate predicted probabilities of infarct pattern and infarct size, and of infarct pattern at surgical revascularisation. The ACS risk calculator was also used to predict 5-year CVD risk using information routinely recorded on discharge following an ACS, with patients being categorised into risk deciles as described previously. 7211a4ac4a