European Society of Cardiology/ European Association for the Study of Diabetes
2019 ESC Guidelines on diabetes, pre-diabetes,
and cardiovascular diseases developed
in collaboration with the EASD
In patients with DM at high/very high risk, aspirin (75-100 mg/day) may be considered in primary prevention in the absence of clear contraindications (Class IIb, level A).
In patients with DM at moderate CV risk, aspirin for primary prevention is not recommended (Class III, level B).
When low-dose aspirin is used, proton pump inhibitors should be considered to prevent gastrointestinal bleeding (Class IIa, level A).
Aspirin at a dose of 75-160 mg/day is recommended as secondary prevention in patients with DM (Class I, level A).1
Treatment with a P2Y12 receptor blocker, ticagrelor or prasugrel, is recommended in patients with DM and ACS for 1 year with aspirin, and in those who undergo PCI or CABG (Class I, level A).1
Concomitant use of a proton pump inhibitor is recommended in patients receiving DAPT or oral anticoagulant monotherapy who are at high risk of gastrointestinal bleeding (Class I, level A).1
Prolongation of DAPT beyond 12 months should be considered for up to 3 years, in patients with DM who have tolerated DAPT without major bleeding complications(Class IIa, level A).1
The addition of a second antithrombotic drug on top of aspirin for long-term secondary prevention should be considered in patients without high bleeding risk(Class IIa, level A).1
*Gastrointestinal bleeding, peptic ulceration within the previous 6 months, active hepatic disease, or history of aspirin allergy.
ESC: European Society of Cardiology; EASD: European Association for the Study of Diabetes; DM: diabetes mellitus; CV: cardiovascular; P2Y12: platelet adenosine diphosphate P2Y12 receptor; ACS: acute coronary syndrome; CCS: chronic coronary syndrome; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft; DAPT: dual antiplatelet therapy.
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