Antithrombotic Regimens in Patients with ACS and an Indication for Oral Anticoagulation

• Default Strategy:

• 1 week:

• Triple Antithrombotic Therapy (TAT): OAC + DAPT (Dual Antiplatelet Therapy) (class I).

• 1 month to 6 months:

• Dual Antithrombotic Therapy (DAT): OAC + SAPT (Single Antiplatelet Therapy) (class I), with clopidogrel used as SAPT.

• 6 months to 12 months:

• Continuation of DAT: OAC + SAPT (class I), with clopidogrel used as SAPT.

• OAC monotherapy (class IIb) may be considered.

• Beyond 12 months:

• OAC monotherapy (class IIb).

• Patients with High Ischemic Risk:

• 1 week:

• TAT: OAC + DAPT (class IIa).

• 1 month to 6 months:

• DAT: OAC + SAPT (class I), with clopidogrel used as SAPT.

• 6 months to 12 months:

• Continuation of DAT: OAC + SAPT (class I), with clopidogrel used as SAPT.

• OAC monotherapy (class IIb) may be considered.

• Beyond 12 months:

• OAC monotherapy (class IIb).

• High Ischemic Risk Criteria:

• Multivessel disease

• Stent in the last patent vessel

• Previous stent thrombosis

• Stents longer than 60 mm

• Presence of three or more stents or lesions

• Chronic kidney disease

• Two stents in bifurcation

• CTO PCI (Chronic Total Occlusion Percutaneous Coronary Intervention)