Update on Antithrombotic Therapy after Percutaneous Coronary Intervention

Figures

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  Figure 1.. Basic recommendations concerning the DAPT duration in patients not indicated for oral anticoagulation undergoing percutaneous coronary intervention. The American and European guidelines in 2016 and 2017 recommend DAPT for 3 to 12 months (Class I or IIa) depending on the patient characteristics. The Japanese guidelines in 2018 recommend 6- to 12-month DAPT for ACS and 1- to 3-month DAPT for stable CAD patients with HBR (3-6). ACS: acute coronary syndrome, CAD: coronary artery disease, DAPT: dual antiplatelet therapy, HBR: high bleeding risk

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  Figure 2.. Basic recommendations concerning antithrombotic therapy for patients indicated for oral anticoagulation after PCI. In the North American consensus document (82), the default approach is triple therapy, a combination of aspirin, clopidogrel, and an OAC for patients indicated for life-long anticoagulation treatment after PCI only during index hospitalization, followed by dual therapy with clopidogrel plus an OAC after hospital discharge. If a patient has HBR, dual therapy for up to six months is recommended. For patients with high ischemic and low bleeding risks, triple therapy for up to one month is acceptable. The Japanese guidelines’ recommendation is similar to the North American recommendation (5). The European consensus document recommends one-month triple therapy or dual therapy with an OAC plus clopidogrel as the initial strategy for HBR patients, while triple therapy for up to six months may be considered in patients with a high ischemic risk (83). A DOAC is preferred to a VKA, and clopidogrel is the basic choice of P2Y12 inhibitor for triple or dual therapy. However, the North American perspective and European consensus document indicate ticagrelor as a potential…