European Society of Cardiology
Aspirin as primary prevention strategy
In CCS patients without prior MI or revascularization but with evidence of significant obstructive CAD, aspirin 75–100 mg daily is recommended lifelong (Class: I, Level: B).
Adding a second antithrombotic drug (a P2Y12 inhibitor or low-dose rivaroxaban) to aspirin for long-term secondary prevention should be considered in patients with a high risk of ischemic events and without high bleeding risk (class IIa).
Concomitant use of a proton pump inhibitor is recommended in patients receiving antiplatelet therapy who are at high risk of gastrointestinal bleeding (class I, level A).
Aspirin 75-100 mg daily is recommended for patients with a previous myocardial infarction or revascularization
(class I, level A).
Aspirin is recommended for all patients without contraindications at an initial oral LD of 150–300 mg (or 75–250 mg IV) and an MD of 75–100 mg o.d. for long-term treatment
(class I, level A).
In ACS, DAPT with a P2Y12 inhibitor in addition to aspirin is recommended for 12 months, unless there are contraindications such as excessive risk of bleeding
(class I, level A).
In patients with CCS, clopidogrel 75 mg daily is recommended, in addition to aspirin, for 6 months following coronary stenting, irrespective of stent type, unless a shorter duration is indicated due to risk or the occurrence of life-threatening bleeding
(class I, level A).
ESC: European Society of Cardiology; DM: diabetes mellitus; CVD: cardiovascular disease; P2Y12: platelet adenosine diphosphate P2Y12 receptor; ACS: acute coronary syndrome; DAPT: dual antiplatelet therapy; CCS: chronic coronary syndrome; LD: loading dose; MD: maintenance dose; o.d.: once daily.
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