Flowchart for Class I and Class IIa Recommendations for Initial Management of UA/NSTEMI *A loading dose followed by a daily maintenance dose of either clopidogrel (LOE: B), prasugrel (in PCI-treated patients), or ticagrelor (LOE: C) should be administered to UA/NSTEMI patients who are unable to take ASA because of hypersensitivity or major GI intolerance. If fondaparinux is used during PCI (Class I, LOE: B), it must be coadministered with another anticoagulant with Factor IIa activity (ie, UFH). Timing of invasive strategy generally is assumed to be 4 to 48 h. If immediate angiography is selected, see STEMI guidelines. Precatheterization triple antiplatelet therapy (ASA, clopidogrel or ticagrelor, GP inhibitors) is a Class IIb, LOE: B recommendation for selected high-risk patients. Also, note that there are no data for therapy with 2 concurrent P2Y12 receptor inhibitors, and this is not recommended in the case of aspirin allergy. ASA indicates aspirin; CABG, coronary artery bypass graft; D/C, discontinue; GI, gastrointestinal; GP, glycoprotein; IV, intravenous; LOE, level of evidence; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction; UA/NSTEMI, unstable angina/non ST-elevation myocardial infarction; and UFH, unfractionated heparin. Modified from Wright et al.6 Jneid et al 2012 UA/NSTEMI Focused Update 909 Appendix 6. 