Dual antiplatelet therapy for percutaneous coronary intervention
For patients with a STEMI undergoing primary percutaneous coronary intervention (PCI) or in whom PCI is planned, give aspirin plus a P2Y12 inhibitor; use:
aspirin 300 mg orally, chewed or dissolved before swallowing, for the first dose, then 100 to 150 mg daily1 aspirin aspirin aspirin
PLUS ONE OF THE FOLLOWING
1prasugrel 60 mg orally, for the first dose, then 10 mg daily23 prasugrel prasugrel prasugrel
OR
1ticagrelor 180 mg orally, for the first dose, then 90 mg twice daily ticagrelor ticagrelor ticagrelor
OR
2clopidogrel 600 mg orally, for the first dose, then 75 mg daily. clopidogrel clopidogrel clopidogrel
The preferred P2Y12 inhibitors for a patient undergoing PCI are ticagrelor and prasugrel; these have more rapid onset of action, less variable platelet inhibition, and better clinical outcomes than clopidogrelCollet, 2021Wallentin, 2009Wiviott, 2007.
Clopidogrel is used if ticagrelor and prasugrel are not available or are contraindicated4, including if the patient:
- is being treated with thrombolytic therapy
- has a separate indication for oral anticoagulation
- has a high or very high bleeding risk (eg a PRECISE-DAPT score of more than 25 or a HAS-BLED score of more than 3)
- has had prior intracranial haemorrhage or stroke, recent gastrointestinal bleeding or anaemia, or has a coagulopathy
- has liver failure, or severe kidney failure (estimated glomerular filtration rate [eGFR] less than 15 mL/min or requiring dialysis)
- is of extreme old age or frail.
See Antithrombotic therapy after insertion of a coronary artery stent for long-term management of antithrombotic therapy for patients with a stent.