Diagnosis and Assessment A. PCI
ÎFor long-term treatment after percutaneous coronary intervention (PCI), the ACCP recommends aspirin at a dose of 75-100 mg/d (1A).
ÎFor PCI with bare metal stent (BMS) placement, the ACCP recommends aspirin (75-100mg/d) plus clopidogrel†
over aspirin alone (1A).
ÎFor PCI with BMS placement following ACS, the ACCP recommends 12 months of aspirin (75-100 mg/d) plus clopidogrel†
(75 mg/d) over aspirin alone (1A).
ÎFor PCI with a DES, the ACCP recommends aspirin (75-100 mg/d) plus clopidogrel†
months). Beyond 1 year, the ACCP suggests continued treatment with aspirin plus clopidogrel†
(75mg/d for ≥ 12months) (1A for 3 to 4 months; 1B for 4 to 12 indefinitely if no bleeding or other tolerability issues (2C).
ÎFor stent placement with a strong concomitant indication for VKA, the ACCP suggests triple antithrombotic therapy (2C). The ACCP suggests 4 weeks of clopidogrel†
following BMS and 1 year following DES (2C).
Values and preferences: This recommendation places a high value on the prevention of thromboembolism, including stent thrombosis, and a lower value on minimizing bleeding risk.
ÎAfter stent placement, the ACCP suggests clopidogrel† (2B) over cilostazol. The ACCP recommends clopidogrel† (1A).
(1A) or ticlopidine over ticlopidine
ÎFor aspirin-intolerant patients undergoing PCI, the ACCP recommends use of a thienopyridine derivative rather than dipyridamole (1B).
ÎFor PCI with no other indication for VKA, the ACCP recommends against VKA (1A).
B. CABG
ÎFor coronary artery bypass grafting (CABG), the ACCP recommends aspirin, 75 to 100 mg/d, indefinitely (1A). The ACCP suggests that the aspirin be started postoperatively (2A).
ÎFor CABG, the ACCP recommends against addition of dipyridamole to aspirin therapy (1A).
ÎFor CAD undergoing CABG who are allergic to aspirin, the ACCP recommends clopidogrel†
operation followed by 75 mg/d PO indefinitely (1B). ÎFor CABG following NSTE-ACS, the ACCP suggests clopidogrel†
suggests discontinuing clopidogrel† surgery (2A).
, 300 mg, as a loading dose 6 hours after
to 12 months following the procedure in addition to treatment with aspirin (2B). ÎFor patients scheduled for CABG who have received clopidogrel†
, 75mg/d, for 9 for 5 days prior to the scheduled
ÎFor CABG with no other indication for VKA, the ACCP recommends clinicians not administer VKAs (1C).
ÎFor CABG with an indication for oral anticoagulants, such as heart valve replacement, the ACCP suggests VKA in addition to aspirin (2C).
†FDA warning: Clopidogrel (Plavix) can be less effective in poor metabolizers. , the ACCP
