Patients with advanced CKD exhibit high residual platelet reactivity despite treatment with clopi- dogrel independent of the presence of diabetes mellitus.664 Hyporesponsiveness to thienopyridines is associated with increased adverse cardiovascular outcomes, including car- and higher dosing regimens of clopidogrel do not appear to further suppress adenosine diphosphate-induced platelet aggregation.664,666 Although prasugrel may be more efficient than doubling the dose of clopidogrel in achieving adequate platelet inhi- no clinical studies have demonstrated its efficacy in patients with CKD with ACS. Ticagrelor, however, was studied in a prespecified analysis from the PLATO trial.668 In patients with an estimated GFR <60 mL per minute (nearly 21% of patients in PLATO with available central laboratory serum creatinine levels), ticagrelor significantly reduced the primary cardiovascular endpoint (17.3% versus 22.0%; HR: 0.77; 95% CI: 0.65 to 0.90) compared with clopido- Notably, this was associated with a 4% absolute risk reduction in all-cause mortality favoring ticagrelor and with no differences in major bleeding, fatal bleeding, and non CABG-related major bleeding events, demonstrating its util- ity in patients with renal insufficiency. Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e389 7.7. Women: Recommendations Class I 1. Women with NSTE-ACS should be managed with the same pharmacological therapy as that for men for acute care and for secondary prevention, with atten- tion to weight and/or renally calculated doses of anti- platelet and anticoagulant agents to reduce bleeding (Level of Evidence: B) 2. Women with NSTE-ACS and high-risk features (eg, troponin positive) should undergo an early invasive (Level of Evidence: A) Class IIa 1. Myocardial revascularization is reasonable in preg- nant women with NSTE-ACS if an ischemia-guided strategy is ineffective for management of life- (Level of Evidence: C) Class III: No Benefit 1. 