<unk>  is used to prevent heart attack and stroke in people who are at high risk of these events, including those with a history of myocardial infarction and other forms of acute coronary syndrome, stroke, and those with peripheral artery disease. Treatment with<unk>  or a related drug is recommended by the American Heart Association and the American College of Cardiology for people who: * Present for treatment with a myocardial infarction with ST-elevation including :* A loading dose given in advance of percutaneous coronary intervention (PCI), followed by a full year of treatment for those receiving a vascular stent :* A loading dose given in advance of fibrinolytic therapy, continued for at least 14 days * Present for treatment of a non-ST elevation myocardial infarction or unstable angina :* Including a loading dose and maintenance therapy in those receiving PCI and unable to tolerate aspirin therapy :* Maintenance therapy for up to 12 months in those at medium to high risk for which a noninvasive treatment strategy is chosen * In those with stable ischemic heart disease, treatment with<unk>  is described as a "reasonable" option for monotherapy in those who cannot tolerate aspirin, as is treatment with<unk>  in combination with aspirin in certain high risk patients. It is also used, along with acetylsalicylic acid (ASA, aspirin), for the prevention of thrombosis after placement of a coronary stent or as an alternative antiplatelet drug for people intolerant to aspirin. It is available as a fixed-dose combination.<unk> 's benefit is primarily in those who smoke cigarettes (25% benefit), with only slight (8%) benefit in those who do not smoke cigarettes. Consensus-based therapeutic guidelines also recommend the use of<unk>  rather than aspirin (ASA) for antiplatelet therapy in people with a history of gastric ulceration, as inhibition of the synthesis of prostaglandins by ASA can exacerbate this condition. In people with healed ASA-induced ulcers, however, those receiving ASA plus the proton-pump inhibitor (PPI) esomeprazole had a lower incidence of recurrent ulcer bleeding than those receiving<unk> . However, prophylaxis with proton-pump inhibitors along with<unk>  following acute coronary syndrome may increase adverse cardiac outcomes, possibly due to inhibition of CYP2C19, which is required for the conversion of<unk>  to its active form. The European Medicines Agency has issued a public statement on a possible interaction between<unk>  and proton-pump inhibitors. However, several cardiologists have voiced concern that the studies on which these warnings are based have many limitations and that it is not certain whether an interaction between<unk>  and proton-pump inhibitors is real.
Clopidogrel
Ticlopidine
Ticagrelor
Prokarin
Apixaban
Rivaroxaban
Warfarin
Heparin