The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

No ASA allergy

ASA allergy

No ASA allergy

ASA allergy

No stent implanted

Stent implanted

STEMI patient at

discharge

Preferred:

ASA 75–162 mgclass I; LOE: A

Alternative:

ASA 75–162 mg

warfarin

(INR 2.0–3.0)§class IIa; LOE: B

or

warfarin

(INR 2.5–3.5)

class IIa; LOE: B

Clopidogrel 75 mgclass I; LOE: B

Clopidogrel 75 mg

warfarin

(INR 2.0–3.0)§class I; LOE: C

No indications

for anticoagulation

Indications foranticoagulation

Alternative:

warfarin

INR (2.5–3.5)class I; LOE: B

ASA 75–162 mg

warfarin

(INR 2.0–3.0)§class I; LOE B

or

warfarin

(INR 2.5–3.5)class I; LOE: B

Preferred:*

clopidogrel 75 mgclass I; LOE: C

Warfarin

INR (2.5–3.5)class I; LOE: B

ASA 75–162 mgclopidogrel 75 mg†class I; LOE: B

ASA 75–162 mgclopidogrel 75 mg‡

warfarin (INR 2.0–3.0)§

class IIb; LOE: C

No indications

for anticoagulation

Indications

for anticoagulation

No indications

for anticoagulation

Indications

for anticoagulation

No indications

for anticoagulation

Indications

for anticoagulation

Fig. 3.11

Long-term antithrombotic therapy at hospital discharge after STEMI.

* Clopidogrel is preferred over warfarin due to increased risk of bleeding and low patient compliance in warfarin trials.† For 12 months.‡ Discontinue clopidogrel 1 month after implantation of a bare metal stent or several months after implantation of a drug-eluti

ng stent (3 months after sirolimus and 6 months after paclitaxel) because of the potential increased risk of

bleeding with warfarin and two antiplatelet agents.

Continue ASA and warfarin long term if warfarin is indicated for other reasons such as atrial fi brillation, LV thrombus, cerebr

al emboli, or extensive regional wall motion abnormality.

§ An INR of 2.0–3.0 is acceptable with tight control, but the lower end of this range is preferable. The combination of antipla

telet therapy and warfarin may be considered in patients aged less than 75 years, with low bleeding risk, and who

can be monitored reliably.LOE, Level of evidence.