35
4.3.1. Antiplatelet Therapy and Oral Anticoagulants (OAC)
(cont'd)
COR LOE
Recommendations
Antiplatelet erapy Without OAC (cont'd)
3: Harm B-R 9. In patients with CCD and previous stroke, TIA, or ICH,
prasugrel should not be used because of risk of significant or
fatal bleeding.
3: Harm B-R 10. In patients with CCD, chronic nonsteroidal anti-
inflammatory drugs should not be used because of increased
cardiovascular and bleeding complications.*
Antiplatelet erapy With Direct OAC (DOAC)
1 B-R 11. In patients with CCD who have undergone elective PCI and
who require oral anticoagulant therapy, DAPT for 1 to 4
weeks followed by clopidogrel alone for 6 months should be
administered in addition to DOAC.
†
2a B-R 12. In patients with CCD who have undergone PCI and who
require oral anticoagulant therapy, continuing aspirin in
addition to clopidogrel for up to 1 month is reasonable if the
patient has a high thrombotic risk and low bleeding risk.*
2b B-R 13. In patients with CCD who require oral anticoagulation
and have a low atherothrombotic risk, discontinuation of
aspirin therapy with continuation of DOAC alone may be
considered 1 year after PCI to reduce bleeding risk.*
2b C-LD 14. In patients with CCD who require oral anticoagulation,
DOAC monotherapy may be considered if there is no acute
indication for concomitant antiplatelet therapy.
Antiplatelet erapy and Low-Dose DOAC
2a B-R 15. In patients with CCD without an indication for therapeutic
DOAC or DAPT and who are at high risk of recurrent
ischemic events but low-to-moderate bleeding risk, the
addition of low-dose rivaroxaban 2.5 mg twice daily to
aspirin 81 mg daily is reasonable for long-term reduction of
risk for MACE.
DAPT and Proton Pump Inhibitor (PPI)
2a B-R 16. In patients with CCD on DAPT, the use of a PPI can be
effective in reducing gastrointestinal bleeding risk.*
* Modified from the 2016 ACC/AHA guideline focused update on duration of DAPT with
coronary artery disease. Levine GN, et al. Circulation. 2016;134:e123-155.
†
Modified from the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization.
Lawton JS, et al. J Am Coll Cardiol. 2022;79:e21-e129.
