Coronary Artery Disease: Stent Therapy Use of Triple Anticoagulation Treatment

Coronary Artery Disease: Stent Therapy Use of Triple Anticoagulation Treatment

Coronary Artery Disease: Stent Therapy Use of Triple Anticoagulation Treatment - Flowchart

«Flowchart»

High Embolic Risk AF
CHA₂DS₂-VASc score (2)

High Embolic Risk AF
CHA₂DS₂-VASc score (2)

High Embolic Risk AF
CHA₂DS₂-VASc score (2)

High Embolic Risk AF
₂ ₂

Warfarin

Warfarin

Warfarin

Warfarin

Warfarin

Warfarin

High-risk bleeding
HAS-BLED score 3

High-risk bleeding
HAS-BLED score 3

High-risk bleeding
HAS-BLED score 3

Low-risk bleeding
HAS-BLED score 0-2

Low-risk bleeding
HAS-BLED score 0-2

Low-risk bleeding
HAS-BLED score 0-2

CCS

CCS

CCS

ACS

ACS

ACS

BMS or DES

BMS or DES

BMS or DES

BMS/DES

BMS/DES

BMS/DES

TAT 1 mo (BMS)
3-6 mo (DES)^a

TAT 1 mo (BMS)
3-6 mo (DES)^a

TAT 1 mo (BMS)
3-6 mo (DES)^a

^a a a

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

Lifelong warfarin Rx (INR 2-3)

Lifelong warfarin Rx (INR 2-3)

Lifelong warfarin Rx (INR 2-3)

End

End

End

TAT 6 mo

TAT 6 mo

TAT 6 mo

CCS

CCS

CCS

ACS

ACS

ACS

BMS/DES

BMS/DES

BMS/DES

TAT 2-4 wk

TAT 2-4 wk

TAT 2-4 wk

TAT 1 mo

TAT 1 mo

TAT 1 mo

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

Warfarin (INR 2-2.5) or NOAC + Clopidogrel (75 mg) or ASA (81 mg)
Up to 12 mo

BMS

BMS

BMS

DES

DES

DES

^a DES stents if sirolimus, everolimus, or tacrolimus require 3-mo dual platelet therapy (ASA plus clopidogrel). If DES stent is paclitaxel, 6-mo dual therapy is required.

^a DES stents if sirolimus, everolimus, or tacrolimus require 3-mo dual platelet therapy (ASA plus clopidogrel). If DES stent is paclitaxel, 6-mo dual therapy is required.

^a DES stents if sirolimus, everolimus, or tacrolimus require 3-mo dual platelet therapy (ASA plus clopidogrel). If DES stent is paclitaxel, 6-mo dual therapy is required.

^a a

ACS, acute coronary syndrome; AF, atrial fibrillation; ASA, aspirin; BMS, bare-metal stent; CCS, patient with chronic coronary syndrome (stable coronary artery disease); DES, drug eluting stent; INR, international normalized ratio; Rx, therapy [warfarin (INR 2-2.5) + aspirin (81 mg daily) + clopidogrel (75 mg daily)]; TAT, triple anticoagulation therapy.

ACS, acute coronary syndrome; AF, atrial fibrillation; ASA, aspirin; BMS, bare-metal stent; CCS, patient with chronic coronary syndrome (stable coronary artery disease); DES, drug eluting stent; INR, international normalized ratio; Rx, therapy [warfarin (INR 2-2.5) + aspirin (81 mg daily) + clopidogrel (75 mg daily)]; TAT, triple anticoagulation therapy.

ACS, acute coronary syndrome; AF, atrial fibrillation; ASA, aspirin; BMS, bare-metal stent; CCS, patient with chronic coronary syndrome (stable coronary artery disease); DES, drug eluting stent; INR, international normalized ratio; Rx, therapy [warfarin (INR 2-2.5) + aspirin (81 mg daily) + clopidogrel (75 mg daily)]; TAT, triple anticoagulation therapy.