21
Table 16. Late Hospital Care, Hospital Discharge, and
Posthospital Discharge Care (cont'd)
Recommendations
COR LOE
Late hospital and posthospital oral antiplatelet therapy (cont'd)
In patients receiving a stent (bare-metal stent or DES) during PCI
for NSTE-ACS, P2Y
12
inhibitor therapy should be given for ≥12
months. Options include:
• Clopidogrel: 75 mg daily or
• Prasugrel:
a
10 mg daily or
• Ticagrelor:
b
90 mg twice daily
I B
It is reasonable to use an ASA maintenance dose of 81 mg per day
in preference to higher maintenance doses in patients with NSTE-
ACS treated either invasively or with coronary stent implantation.
IIa B
It is reasonable to use ticagrelor in preference to clopidogrel for
maintenance P2Y
12
treatment in patients with NSTE-ACS who
undergo an early invasive or ischemia-guided strateg y.
IIa B
It is reasonable to choose prasugrel over clopidogrel for
maintenance P2Y
12
treatment in patients with NSTE-ACS who
undergo PCI who are not at high risk for bleeding complications.
IIa B
If the risk of morbidity from bleeding outweighs the anticipated
benefit of a recommended duration of P2Y
12
inhibitor therapy aer
stent implantation, earlier discontinuation (e.g., <12 months) of
P2Y
12
inhibitor therapy is reasonable.
IIa C
Continuation of DAPT beyond 12 months may be considered in
patients undergoing stent implantation.
IIb C
Combined oral anticoagulant therapy and antiplatelet therapy in patients
with NSTE-ACS
e duration of triple antithrombotic therapy with a vitamin K
antagonist, ASA, and a P2Y
12
receptor inhibitor in patients with
NSTE-ACS should be minimized to the extent possible to limit
the risk of bleeding.
I C
Proton pump inhibitors should be prescribed in patients with
NSTE-ACS with a history of gastrointestinal bleeding who require
triple antithrombotic therapy with a vitamin K antagonist, ASA,
and a P2Y
12
receptor inhibitor.
I C
Proton pump inhibitor use is reasonable in patients with NSTE-
ACS without a known history of gastrointestinal bleeding who
require triple antithrombotic therapy with a vitamin K antagonist,
ASA, and a P2Y
12
receptor inhibitor.
IIa C
Targeting oral anticoagulant therapy to a lower international
normalized ratio (e.g., 2.0-2.5) may be reasonable in patients with
NSTE-ACS managed with ASA and a P2Y
12
inhibitor.
IIb C
a
Patients should receive a loading dose of prasugrel provided that they were not pretreated with
another P2Y
12
receptor inhibitor.
b
e recommended maintenance dose of ASA to be used with ticagrelor is 81 mg daily.
