Definitions
These treatments are strongly recommended
What is Class I?
Patients with stable ischemic heart disease who receive DES should receive this treatment
What is aspirin indefinitely and P2Y12 inhibitor for at least 6 months?
For patients with NSTE-ACS who are treated with medical therapy alone, it is reasonable to use this P2Y12 inhibitor in place of clopidogrel
What is ticagrelor?
It may be reasonable for patients with ACS who are treated only with medical therapy to modify DAPT timeline in this way if they do not have high risk of bleeding and have had no overt bleeding
What is continue DAPT for longer than 12 months?
The P2Y12 inhibitor that should not be used by patient with a history of stroke or TIA
What is prasugrel?
The 2 components that make up DAPT
What is aspirin and P2Y12 inhibitor?
Patients with ACS who receive BMS or DES should receive this treatment
What is aspirin indefinitely and P2Y12 inhibitor for at least 12 months?
It is reasonable for patients with ACS + stent without high bleeding risk or history of stroke/TIA to use this P2Y12 inhibitor in place of clopidogrel
What is prasugrel?
It may be reasonable for patients with SIHD who recieve DES and have high risk of bleeding or who have overt bleeding to stop P2Y12 inhibitor after this length of time
What is 3 months?
Unless history of these events, DAPT in SIHD is not beneficial
What is CABG within the last 12 months, prior ACS, or stent implantation?
These treatments are reasonable and have high quality evidence
What is class IIa?
Patients with ACS treated with DAPT (post-stent) who then undergo CABG should follow this treatment regimen post-op
What is resume aspirin indefinitely and P2Y12 inhibitor for 12 months from ACS event?
For patients with ACS who are treated with stent, it is reasonable to use this P2Y12 inhibitor in place of clopidogrel
What is ticagrelor?
It may be reasonable for patients with SIHD who then undergo CABG to follow this treatment regimen post-op
What is aspirin and P2Y12 inhibitor for 12 months post-CABG?
If DAPT would need to be discontinued peri-op, it would be harmful to undergo elective non-cardiac surgery within this timeframe of DES implantation
What is 3 months?
These treatments have either no benefit or cause harm
What is Class III?
Patients with ACS who are treated only with medical therapy should receive this treatment
What is aspirin indefinitely and P2Y12 inhibitor for at least 12 months?
BONUS: aspirin antiplatelet mechansim
What is irreversibly inhibits cyclooxygenase 1 -> inhibits production of thromboxane A2 -> inhibits platelet activation
It may be reasonable for patients with ACS treated with stent who have high risk of bleeding or who have overt bleeding to stop P2Y12 inhibitor after this length of time
What is 6 months?
If DAPT would need to be discontinued peri-op, it would be harmful to undergo elective non-cardiac surgery within this timeframe of BMS implantation
What is 30 days?
These treatments may be reasonable and have moderate quality evidence
What is Class IIb?
Patients with STEMI treated with fibrinolytic therapy should receive this treatment
What is aspirin indefinitely and P2Y12 inhibitor for a minimum of 14 days and ideally at least 12 months?
BONUS: major characteristic that differentiates ticagrelor from other P2Y12 inhibitors
What is reversible inhibition?
It may be reasonable for patients with STEMI who are treated with fibrinolytic therapy to modify DAPT timeline in this way if they do not have high risk of bleeding and have had no overt bleeding
What is continue DAPT for longer than 12 months?
BONUS: P2Y12 inhibitor antiplatelet mechanism (other than ticagrelor)
What is competitively inhibits ADP binding to P2Y12 receptor -> inhibits platelet activation