13
Can consider GPI in addition to ASA
and P2Y
12
inhibitor in high-risk (e.g.,
troponin positive) patients (Class IIb;
LOE: B)
• Eptifibatide
• Tirofiban
Early Invasive Strateg y
Initiate DAPT and
Anticoagulant Therapy
1. ASA (Class I; LOE: A)
2. P2Y
12
inhibitor (in addition to
ASA) (Class I; LOE: B):
• Clopidogrel or
• Ticagrelor
3. Anticoagulant:
• UFH (Class I; LOE: B) or
• Enoxaparin (Class I; LOE: A) or
• Fondaparinux
b
(Class I; LOE: B)
or
• Bivalirudin (Class I; LOE: B)
Late Hospital/Posthospital Care
1. ASA indefinitely (Class I; LOE: A)
2. P2Y
12
inhibitor (clopidogrel or
ticagrelor), in addition to ASA,
≤12 months if medically treated
(Class I; LOE: B)
3. P2Y
12
inhibitor (clopidogrel,
prasugrel, or ticagrelor), in addition
to ASA, ≥12 months if treated with
coronary stenting (Class I; LOE: B)
CABG
Initiate/continue ASA therapy and
discontinue P2Y
12
and/or GPI
therapy
1. ASA (Class I; LOE: B)
2. Discontinue clopidogrel/ticagrelor
5 days before, and prasugrel ≥7 days
before elective CABG
3. Discontinue clopidogrel/ticagrelor
≤24 h before urgent CABG (Class
I; LOE: B). May perform urgent
CABG <5 days after clopidogrel/
ticagrelor and <7 days after
prasugrel discontinued
4. Discontinue eptifibatide/tirofiban
at least 2-4 h before, and abciximab
≥12 h before CABG (Class I;
LOE: B)
a
See corresponding full-sentence
recommendations and their explanatory
footnotes.
b
In patients who have been treated with
fondaparinux (as upfront therapy) who are
undergoing PCI, an additional anticoagulant
with anti-IIa activity should be administered at
the time of PCI because of the risk of catheter
thrombosis.
