34
Treatment
4.2.12. Environmental Exposures
COR LOE
Recommendations
2a B-NR 1. In patients with CCD, minimization of exposure to ambient air
pollution is reasonable to reduce the risk of cardiovascular events.
2b B-NR 2. In patients with CCD, minimization of climate-related
exposures (eg, extreme temperatures, wildfire smoke) may be
reasonable to reduce the risk of cardiovascular events.
4.3.1. Antiplatelet Therapy and Oral Anticoagulants (OAC)
COR LOE
Recommendations
Antiplatelet erapy Without OAC
1 A 1. In patients with CCD and no indication for OAC therapy,
low-dose aspirin 81 mg (75–100 mg ) is recommended to
reduce atherosclerotic events.*
1 A 2. In patients with CCD treated with PCI, dual antiplatelet
therapy (DAPT) consisting of aspirin and clopidogrel for
6 months post PCI followed by single antiplatelet therapy
(SAPT) is indicated to reduce MACE and bleeding events.*
2a A 3. In select patients with CCD treated with PCI and a drug-
eluting stent (DES) who have completed a 1- to 3-month
course of DAPT, P2Y12 inhibitor monotherapy for at least 12
months is reasonable to reduce bleeding risk.
2b A 4. In patients with CCD who have had a previous MI and are at
low bleeding risk, extended DAPT beyond 12 months for a
period of up to 3 years may be reasonable to reduce MACE.*
2b B-R 5. In patients with CCD and a previous history of MI without
a history of stroke, TIA, or ICH, vorapaxar may be added to
aspirin therapy to reduce MACE.
2b B-R 6. In patients with CCD, the use of DAPT after CABG may be
useful to reduce the incidence of saphenous vein graft occlusion.
3: No
benefit
A 7. In patients with CCD without recent ACS or a PCI-related
indication for DAPT, the addition of clopidogrel to aspirin
therapy is not useful to reduce MACE.*
3: Harm A 8. In patients with CCD and previous stroke, TIA, or ICH,
vorapaxar should not be added to DAPT because of increased
risk of major bleeding and ICH.
4.3. Medical Therapy to Prevent Cardiovascular Events and
Manage Symptoms
