Do not use prasugrel in patients with active pathological bleeding or a history of TIA or stroke. In patients age 75 y, prasugrel is generally not recommended because of the increased risk of fatal and intracranial bleeding and uncertain benefit except in high-risk situations (patients with diabetes or a history of prior myocardial infarction), in which its effect appears to be greater and its use may be considered. Do not start prasugrel in patients likely to undergo urgent CABG. When possible, discontinue prasugrel at least 7 d before any surgery.8 Additional risk factors for bleeding include body weight 60 kg, propensity to bleed, and concomitant use of medications that increase the risk of bleeding (eg, warfarin, heparin, fibrinolytic therapy, or chronic use of nonsteroidal anti-inflammatory drugs).8 Continue aspirin indefinitely and warfarin longer term as indicated for specific conditions such as atrial fibrillation; LV thrombus; or cerebral, venous, or pulmonary emboli. An INR of 2.0 to 2.5 is preferable while given with aspirin and a P2Y12 receptor inhibitor, especially in older patients and those with other risk factors for bleeding. For UA/NSTEMI patients who have mechanical heart valves, the INR should be at least 2.5 (based on type of prosthesis). BMS indicates bare-metal stent; CABG, coronary artery bypass graft; DES, drug-eluting stent; GI, gastrointestinal; INR, international normalized ratio; LV, left ventricular; PCI, percutaneous coronary intervention; PPI, proton pump inhibitor; TIA, transient ischemic attack; and UA/NSTEMI, unstable angina/non ST-elevation myocardial infarction. Jneid et al 2012 UA/NSTEMI Focused Update 891 5.2.6. Warfarin Therapy: Recommendations (See Table 6.) 6. Special Groups 6.2. Diabetes Mellitus: Recommendations (See Table 7.) 6.2.1.1. Intensive Glucose Control As detailed in the 2004 STEMI guideline,153 2007 UA/ NSTEMI guideline revision,4 and 2009 STEMI and PCI focused update,154 randomized trial evidence supported use of insulin infusion to control hyperglycemia. 