Treatment
Thromboembolic and Bleeding Complications
ÎÎAnticoagulant therapy with a vitamin K antagonist should be provided to
patients with STEMI and atrial fibrillation (AF) with CHADS2 scorea ≥2,
mechanical heart valves, venous thromboembolism, or hypercoagulable
disorder. (I-C)
Note: These recommendations apply to patients who receive intracoronary stents during
PCI for STEMI. Among individuals with STEMI who do not receive an intracoronary
stent, the duration of DAPT beyond 14 days has not been studied adequately for
patients who undergo balloon angioplasty alone, are treated with fibrinolysis alone,
or do not receive reperfusion therapy. In this subset of patients with STEMI who do
not receive an intracoronary stent, the threshold for initiation of oral anticoagulation
for secondary prevention, either alone or in combination with aspirin, may be lower,
especially if a shorter duration (ie,14 days) of DAPT is planned.
ÎÎThe duration of triple antithrombotic therapy with a vitamin K
antagonist, aspirin, and a P2Y12 receptor inhibitor should be
minimized to the extent possible to limit the risk of bleeding. (I-C)
Note: Individual circumstances will vary and depend on the indications for triple
therapy and the type of stent placed during PCI. After this initial treatment period,
consider therapy with a vitamin K antagonist plus a single antiplatelet agent. For
patients treated with fibrinolysis, consider triple therapy for 14 days, followed by a
vitamin K antagonist plus a single antiplatelet agent.
ÎÎAnticoagulant therapy with a vitamin K antagonist is reasonable for
patients with STEMI and asymptomatic LV mural thrombi. (IIa-C)
ÎÎAnticoagulant therapy may be considered for patients with STEMI and
anterior-apical akinesis or dyskinesis. (IIb-C)
ÎÎTargeting vitamin K antagonist therapy to a lower international
normalized ratio (eg, 2.0-2.5) might be considered in patients with
STEMI who are receiving DAPT. (IIb-C)
a
CHADS2 = (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, previous
Stroke/transient ischemic attack [doubled risk weight]) score.
CHADS2 Risk Criteria
Congestive heart failure
Hypertension
Age 75 y
Diabetes mellitus
Prior Stroke or TIA
24
Score
1
1
1
1
2
