Coronary heart disease secondary prevention antiplatelet agents/anticoagulants

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Type 2 Diabetes Mellitus Management

ACC / AHA 2011 Guidelines - Coronary Heart Disease - Secondary Prevention with Diabetes Mellitus Management (DO NOT EDIT)

Class I

"1. Aspirin 75–162 mg daily is recommended in all patients with coronary artery disease unless contraindicated. (Level A) Clopidogrel 75 mg daily is recommended as an alternative for patients who are intolerant of or allergic to aspirin. (Level B)"

"2. A P2Y12 receptor antagonist in combination with aspirin is indicated in patients after ACS or PCI with stent placement. (Level A) For patients receiving a bare-metal stent or drug-eluting stent during PCI for ACS, clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice daily should be given for at least 12 months. (Level A)"

"3. For patients undergoing coronary artery bypass grafting, aspirin should be started within 6 hours after surgery to reduce saphenous vein graft closure. Dosing regimens ranging from 100 to 325 mg daily for 1 year appear to be efficacious. (Level A)"

"4. In patients with extracranial carotid or vertebral atherosclerosis who have had ischemic stroke or TIA, treatment with aspirin alone (75–325 mg daily), clopidogrel alone (75 mg daily), or the combination of aspirin plus extended-release dipyridamole (25 mg and 200 mg twice daily, respectively) should be started and continued. (Level B)"

"5. For patients with symptomatic atherosclerotic peripheral artery disease of the lower extremity, antiplatelet therapy with aspirin (75–325 mg daily) or clopidogrel (75 mg daily) should be started and continued. (Level A)"

"6. Antiplatelet therapy is recommended in preference to anticoagulant therapy with warfarin or other vitamin K antagonists to treat patients with atherosclerosis. (Level A) If there is a compelling indication for anticoagulant therapy, such as atrial fibrillation, prosthetic heart valve, left ventricular thrombus, or concomitant venous thromboembolic disease, warfarin should be administered in addition to the low-dose aspirin (75–81 mg daily). (Level A) For patients requiring warfarin, therapy should be administered to achieve the recommended INR for the specific condition. (Level B) Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with increased risk of bleeding and should be monitored closely. (Level A)"

Class IIa

"1. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by thienopyridine therapy after stent implantation, earlier discontinuation (eg, <12 months) is reasonable. (Level C) (Note: the risk for serious cardiovascular events because of early discontinuation of thienopyridines is greater for patients with drug-eluting stents than those with bare-metal stents.)"

"2. After PCI, it is reasonable to use 81 mg of aspirin per day in preference to higher maintenance doses. (Level B)"

"3. For patients undergoing coronary artery bypass grafting, clopidogrel (75 mg daily) is a reasonable alternative in patients who are intolerant of or allergic to aspirin. (Level C)"

Class IIb

"1. The benefits of aspirin in patients with asymptomatic peripheral artery disease of the lower extremities are not well established. (Level B)"

"2. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. (Level B"

References

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