a. Clopidogrel 600 mg should be given as early as possible before or at the time of PCI32,73,74 (Level of Evidence: B) or b. Prasugrel* 60 mg should be given promptly and no later than 1 hour after PCI once coronary anatomy is defined and a decision is made to proceed with PCI7 (Level of Evidence: B) or c. Ticagrelor 180 mg should be given as early as possible before or at the time of PCI.9 (Level of Evidence: B) 7. The duration and maintenance dose of P2Y12 receptor inhibitor therapy should be as follows: 2011 recommendation modified (included ticagrelor; a footnote added pertaining to recommended aspirin maintenance dose). a. In UA/NSTEMI patients undergoing PCI, either clopidogrel 75 mg daily,13,16 prasugrel* 10 mg daily,7 or ticagrelor 90 mg twice daily9 should be given for at least 12 months. (Level of Evidence: B) b. If the risk of morbidity because of bleeding outweighs the anticipated benefits afforded by P2Y12 receptor inhibitor therapy, earlier discontinuation should be considered. (Level of Evidence: C) Class IIa 1. For UA/NSTEMI patients in whom an initial conservative strategy is selected and who have recurrent ischemic discomfort with aspirin, a P2Y12 receptor inhibitor (clopidogrel or ticagrelor), and anticoagulant therapy, it is reasonable to add a GP IIb/IIIa inhibitor before diagnostic angiography. (Level of Evidence: C) modified ( clopidogrel replaced with P2Y12 receptor inhibitor [clopidogrel or ticagrelor]). 2. For UA/NSTEMI patients in whom an initial invasive strategy is selected, it is reasonable to omit administration of an IV GP IIb/IIIa inhibitor if bivalirudin is selected as the anticoagulant and at least 300 mg of clopidogrel was administered at least 6 hours earlier than planned catheterization or PCI.57,76,77 (Level of Evidence: B) 2011 recommendation remains current. (Continued) ST-segment elevation ACS. 