Acute Coronary Syndrome First Year – No Percutaneous Coronary Intervention
ÎFor patients in the first year after an ACS who have not undergone PCI:
• The ACCP recommends dual antiplatelet therapy (ticagrelor 90 mg twice daily plus low-dose aspirin 75-100 mg daily or clopidogrel 75 mg daily plus low-dose aspirin 75-100 mg daily) over single antiplatelet therapy (1-B).
First Year – With Stent
ÎFor patients in the first year after an ACS who have undergone PCI with stent placement:
• The ACCP recommends dual antiplatelet therapy (ticagrelor 90 mg twice daily plus low-dose aspirin 75-100 mg daily, clopidogrel 75 mg daily plus low-dose aspirin, or prasugrel 10 mg daily plus low-dose aspirin over single antiplatelet therapy) (1-B). Remark: Evidence suggests that prasugrel results in no benefit or net harm in patients with a body weight of < 60 kg, age > 75 years, or with a previous stroke/transient ischemic attack.
• The ACCP suggests ticagrelor 90 mg twice daily plus low-dose aspirin 75 to 100 mg daily over clopidogrel 75 mg daily plus low-dose aspirin (2-B).
ÎFor patients with ACS who undergo PCI with stent placement, see Percutaneous Coronary Intervention Section for duration of treatment.
Left Ventricular Thrombus No Stent
ÎFor patients with anterior MI and left ventricular (LV) thrombus, or those at high risk for LV thrombus (ejection fraction < 40%, anteroapical wall motion abnormality), who do not undergo stenting:
• For the first 3 months, the ACCP recommends warfarin (international normalized ratio [INR] 2.0-3.0) plus low-dose aspirin 75 to 100 mg daily over single antiplatelet therapy or dual antiplatelet therapy (1-B). Thereafter, the ACCP recommends discontinuation of warfarin and continuation of dual antiplatelet therapy for up to 12 months as per ACCP recommendations for ACS. After 12 months, single antiplatelet therapy is recommended as per established ACCP recommendations for CAD.
Bare-Metal Stent
ÎFor patients with anterior MI and LV thrombus, or those at high risk for LV thrombus (ejection fraction < 40%, anteroapical wall motion abnormality), who undergo BMS placement:
• For the first month, the ACCP suggests triple therapy (warfarin [INR 2.0-3.0], low-dose aspirin 75-100 mg daily, clopidogrel 75 mg daily) over dual antiplatelet therapy (2-C).
• For the second and third month post-BMS, the ACCP suggests warfarin (INR 2.0-3.0) and single antiplatelet therapy over alternative regimens and alternative time frames for warfarin use (2-C). Thereafter, the ACCP recommends discontinuation of warfarin and use of dual antiplatelet therapy for up to 12 months as per ACCP recommendations for ACS. After 12 months, antiplatelet therapy is recommended as per established ACCP recommendations for CAD.
• The ACCP suggests ticagrelor 90 mg twice daily plus low-dose aspirin over clopidogrel 75 mg daily plus low-dose aspirin (2-B).
