Clinical consensus statements for ACS managed by medical therapy alone (no baseline indications for OAC)
| Single antithrombotic therapy |
| Single antithrombotic therapy does not represent the current standard of care unless it is justified by intolerance or contraindications to dual antiplatelet therapy, such as HBR (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| Aspirin provides greater ischaemic protection than no aspirin following acute MI. |
| Clopidogrel provides net benefit compared with aspirin. |
| Dual antithrombotic therapy |
| The combination of aspirin and ticagrelor for up to 12 months is warranted instead of aspirin and clopidogrel unless concerns over the bleeding risk prevail (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| The treatment duration of aspirin and ticagrelor or clopidogrel depends on treatment tolerance, side effects, and assessment of ischaemic vs. bleeding risks. |
| The combination of aspirin and prasugrel is justifiable if clopidogrel and ticagrelor are not indicated, such as in patients receiving strong CYP3A inhibitors if CAD has been confirmed by angiography. |
| The combination of rivaroxaban 2.5 mg b.i.d. with clopidogrel or ticagrelor requires further investigation. |
| Triple antithrombotic therapy |
| Triple antithrombotic therapy with rivaroxaban 2.5 mg b.i.d., aspirin, and clopidogrel has limited evidence in medically managed ACS patients. |
| Single antithrombotic therapy |
| Single antithrombotic therapy does not represent the current standard of care unless it is justified by intolerance or contraindications to dual antiplatelet therapy, such as HBR (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| Aspirin provides greater ischaemic protection than no aspirin following acute MI. |
| Clopidogrel provides net benefit compared with aspirin. |
| Dual antithrombotic therapy |
| The combination of aspirin and ticagrelor for up to 12 months is warranted instead of aspirin and clopidogrel unless concerns over the bleeding risk prevail (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| The treatment duration of aspirin and ticagrelor or clopidogrel depends on treatment tolerance, side effects, and assessment of ischaemic vs. bleeding risks. |
| The combination of aspirin and prasugrel is justifiable if clopidogrel and ticagrelor are not indicated, such as in patients receiving strong CYP3A inhibitors if CAD has been confirmed by angiography. |
| The combination of rivaroxaban 2.5 mg b.i.d. with clopidogrel or ticagrelor requires further investigation. |
| Triple antithrombotic therapy |
| Triple antithrombotic therapy with rivaroxaban 2.5 mg b.i.d., aspirin, and clopidogrel has limited evidence in medically managed ACS patients. |
ACS, acute coronary syndrome; b.i.d., bis in die; CAD, coronary artery disease; HBR, high bleeding risk; MI, myocardial infarction; OAC, oral anticoagulation; PCI, percutaneous coronary intervention.
Clinical consensus statements for ACS managed by medical therapy alone (no baseline indications for OAC)
| Single antithrombotic therapy |
| Single antithrombotic therapy does not represent the current standard of care unless it is justified by intolerance or contraindications to dual antiplatelet therapy, such as HBR (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| Aspirin provides greater ischaemic protection than no aspirin following acute MI. |
| Clopidogrel provides net benefit compared with aspirin. |
| Dual antithrombotic therapy |
| The combination of aspirin and ticagrelor for up to 12 months is warranted instead of aspirin and clopidogrel unless concerns over the bleeding risk prevail (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| The treatment duration of aspirin and ticagrelor or clopidogrel depends on treatment tolerance, side effects, and assessment of ischaemic vs. bleeding risks. |
| The combination of aspirin and prasugrel is justifiable if clopidogrel and ticagrelor are not indicated, such as in patients receiving strong CYP3A inhibitors if CAD has been confirmed by angiography. |
| The combination of rivaroxaban 2.5 mg b.i.d. with clopidogrel or ticagrelor requires further investigation. |
| Triple antithrombotic therapy |
| Triple antithrombotic therapy with rivaroxaban 2.5 mg b.i.d., aspirin, and clopidogrel has limited evidence in medically managed ACS patients. |
| Single antithrombotic therapy |
| Single antithrombotic therapy does not represent the current standard of care unless it is justified by intolerance or contraindications to dual antiplatelet therapy, such as HBR (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| Aspirin provides greater ischaemic protection than no aspirin following acute MI. |
| Clopidogrel provides net benefit compared with aspirin. |
| Dual antithrombotic therapy |
| The combination of aspirin and ticagrelor for up to 12 months is warranted instead of aspirin and clopidogrel unless concerns over the bleeding risk prevail (e.g. based on ARC-HBR criteria or PRECISE-DAPT ≥ 2583). |
| The treatment duration of aspirin and ticagrelor or clopidogrel depends on treatment tolerance, side effects, and assessment of ischaemic vs. bleeding risks. |
| The combination of aspirin and prasugrel is justifiable if clopidogrel and ticagrelor are not indicated, such as in patients receiving strong CYP3A inhibitors if CAD has been confirmed by angiography. |
| The combination of rivaroxaban 2.5 mg b.i.d. with clopidogrel or ticagrelor requires further investigation. |
| Triple antithrombotic therapy |
| Triple antithrombotic therapy with rivaroxaban 2.5 mg b.i.d., aspirin, and clopidogrel has limited evidence in medically managed ACS patients. |
ACS, acute coronary syndrome; b.i.d., bis in die; CAD, coronary artery disease; HBR, high bleeding risk; MI, myocardial infarction; OAC, oral anticoagulation; PCI, percutaneous coronary intervention.
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