The writing group does not recommend that prasugrel be administered routinely to patients with UA/NSTEMI before angiography, Jneid et al 2012 UA/NSTEMI Focused Update 881 such as in an emergency department, or used in patients with UA/NSTEMI who have not undergone PCI. The FDA pack- age label suggests that it is reasonable to consider selective use of prasugrel before catheterization in subgroups of patients for whom a decision to proceed to angiography and PCI has already been established for any reason.8 The writing group acknowledges this flexibility, but it is not its intention to make more specific recommendations about which sub- groups of patients might benefit from prasugrel or ticagrelor instead of clopidogrel. The writing group does wish to caution clinicians about the potential increased bleeding risks associated with prasugrel and ticagrelor compared with clopi- dogrel in specific settings and especially among the sub- groups identified in the package insert and clinical trials.7 9,12 This guideline explicitly does not endorse one of the P2Y12 receptor inhibitors over the other. There were several reasons for this decision. Although the composite efficacy endpoint in TRITON TIMI 38 favored prasugrel, driven predominantly by a difference in nonfatal MIs (mostly asymptomatic), with deaths and nonfatal strokes being similar, bleeding was increased in the prasugrel group.7 On the other hand, the composite efficacy endpoint in PLATO favoring ticagrelor over clopidogrel was driven by differences in both vascular death and nonfatal MIs, with stroke rates being similar. Ticagre- lor was also associated with a notable reduction in all-cause mortality in PLATO. 