In patients with NSTE-ACS and high-risk features (eg, elevated troponin) who are not adequately pretreated #Patients should receive a loading dose of prasugrel, provided that they were not pretreated with another P2Y12 receptor inhibitor. The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily.290 with clopidogrel or ticagrelor, it is useful to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus ep- tifibatide, or high-dose bolus tirofiban) at the time of (Level of Evidence: A) Class IIa 1. In patients with NSTE-ACS and high-risk features (eg, elevated troponin) treated with UFH and ad- equately pretreated with clopidogrel, it is reasonable to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-dose bolus tirofi- ban) at the time of PCI.195,383 (Level of Evidence: B) GP IIb/IIIa receptor antagonist therapy in patients with NSTE-ACS undergoing PCI reduced the incidence of com- posite ischemic events, primarily through a decrease in documented MI, although in some trials this is counter- balanced by an increased rate of bleeding.193,195,310,379 382,392 Most, but not all, randomized trials of the use of GP IIb/IIIa inhibitor were conducted in the era before clopidogrel Abciximab, double-bolus eptifiba- tide, and high-bolus dose tirofiban result in a high degree of platelet inhibition, reduce ischemic complications in patients undergoing PCI, and appear to afford comparable angio- graphic and clinical outcomes.26 As trials of the GP IIb/IIIa inhibitors generally excluded patients at high risk of bleed- ing, recommendations for the use of GP IIb/IIIa inhibitors are best understood as applying to patients not at high risk of bleeding complications. 