The last version of the guideline recommended the use of clopidogrel in patients with UA/NSTEMI because it was the only US Food and Drug Administration (FDA) approved P2Y12 receptor inhibitor in this patient population at that time.6 Since the publication of the last guideline,6 the FDA has approved 2 additional P2Y12 receptor inhibitors for use in patients with UA/NSTEMI. The FDA approved the use of prasugrel and ticagrelor based on data from head-to-head comparison trials with clopidogrel, in which prasugrel and ticagrelor were respectively superior to clopidogrel in reducing clinical events but at the expense of an increased risk of bleeding. The pivotal trial for prasugrel, TRITON TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel Thrombolysis in Myocar- dial Infarction),7 focused on patients with acute coronary syndrome (ACS) who were referred for percutaneous coro- nary intervention (PCI). TRITON TIMI 38 randomly as- Jneid et al 2012 UA/NSTEMI Focused Update 879 signed 13 608 patients with moderate- to high-risk ACS, of whom 10 074 (74%) had UA/NSTEMI, to receive prasugrel (a 60-mg loading dose and a 10-mg daily maintenance dose) or clopidogrel (a 300-mg loading dose and a 75-mg daily maintenance dose) for a median follow-up of 14.5 months. Acetylsalicylic acid (aspirin) was prescribed within 24 hours of PCI. Clinical endpoints were assessed at 30 and 90 days and then at 3-month intervals for 6 to 15 months. Among patients with UA/NSTEMI undergoing PCI, a prasugrel loading dose was administered before, during, or within 1 hour after PCI but only after coronary anatomy had been defined. Patients taking any thienopyridine within 5 days of randomization were excluded. 