Selecting a Treatment Regimen
Antithrombotic Therapy for The Primary and Secondary Prevention of At Risk
≥ 10% 10-year risk High risk Women8
Symptomatic CAD7 After ACS (with and without STE)
If meticulous international normalized ratio (INR) monitoring and highly skilled VKA dose titration are expected and widely accessible
STE
< 75 yo > 75 yo
NSTE High risk1 (2A)
PCI PCI with BMS2
(1A)
PCI with DES (1A for 3 to 4 months; 1B for 4 to 12 months)4 PCI with no other indication for VKA Stents with a strong concomitant indication for VKA
CABG Before CABG Aſter CABG
Aſter CABG for NSTE ACS (2B) IMA bypass
Non-ischemic CHF
1 A large anterior MI, significant heart failure, intracardiac thrombus visible on transthoracic echocardiography, those with atrial fibrill 2 Duration unspecified if not following ACS. 3 For aspirin-intolerant patients undergoing PCI, the ACCP recommends use of a thienopyridine derivative rather than dipyridamole 4 Beyond 1 year, the ACCP suggests continued treatment with aspirin plus clopidogrel†
5 Values and preferences: This recommendation places a high value on the prevention of thromboembolism, including stent thrombosi 6 Aſter stent placement, the ACCP suggests clopidogrel†
7 Values and preferences: This recommendation places a high value on the probable small reduction in arterial vascular risk consequent on add 8 Values and preferences: The recommendation of aspirin over VKA places a relatively low value on a small absolute reduction in coron oral VKA. The low target INR value required in primary prevention typically mandates less frequent monitoring; on average every 2 permitting meticulous monitoring of anticoagulant therapy are available, who place a relatively high value on small absolute risk redu likely to derive the greatest overall benefit from administration of VKA rather than aspirin.
(1A) or ticlopidine (2B) over cilostazol and recommends clopidogrel† †FDA warning: Clopidogrel (Plavix) can be less effective in poor metabolizers.
indefinitely if no bleeding or other tolerability over tic
(2C)5,6
Either (2B) or (2B)
< 65 yo with stroke risk and low risk for m bleed
> 65 yo with stroke or MI risk and low ris major bleed
