4.3 Slide 30 OAC ONLY Diagram

PCI

Percutaneous Coronary Intervention

OAC stands for

Oral Anticoagulant

For patients without OAC and no PCI or >12 months from ACS, what is recommended?

Aspirin monotherapy indefinitely.

For patients without OAC and with prior ACS (with or without PCI), what is recommended?

Dual Antiplatelet Therapy (DAPT) for 12-36 months, then aspirin monotherapy.

For patients without OAC, low/moderate bleeding or ischemic risk after PCI, what is recommended?

DAPT with DES (Drug-Eluting Stent) for 6 months, then SAPT (Single Antiplatelet Therapy).

For patients without OAC, high bleeding risk after PCI, what is recommended?

DAPT for 1-3 months, then P2Y12 monotherapy or SAPT.

What drugs are typically used in DAPT?

Aspirin + P2Y12 inhibitor (e.g., clopidogrel, ticagrelor, prasugrel).

What is SAPT?

Single Antiplatelet Therapy — either aspirin or a P2Y12 inhibitor alone.

What is P2Y12 monotherapy and when is it used?

P2Y12 inhibitor alone (e.g., clopidogrel); used after short DAPT in high bleeding risk PCI patients.

In patients with OAC undergoing PCI with low/moderate bleeding risk, what is the regimen?

DOAC + clopidogrel/aspirin for ≤1 month, then DOAC + clopidogrel for 6 months, then DOAC alone.

In patients with OAC and PCI with high ischemic risk, what is the regimen?

DOAC + clopidogrel/aspirin for 1 month, then DOAC + clopidogrel for 1-6 months, then DOAC alone.

In patients with OAC and no PCI, what is the recommendation?

DOAC monotherapy.

What determines whether DAPT duration is short (1-3 mo) or long (6-12 mo)?

The balance between bleeding risk and ischemic risk.

What is DES?

Drug-Eluting Stent — releases antiproliferative drugs to prevent restenosis.

Why is aspirin typically continued long term in CCD?

For secondary prevention of thrombotic cardiovascular events.

What is the role of DOAC in patients with OAC?

To prevent stroke or systemic embolism in patients with atrial fibrillation or other indications, while balancing bleeding risk.

What is the color code meaning in the chart?

Green = standard/long therapy, Yellow = short duration or high bleeding risk, Orange = OAC monotherapy.

How does high bleeding risk modify therapy?

It shortens DAPT duration and favors early transition to single therapy (P2Y12 or DOAC).

When is aspirin avoided?

In patients on OAC after early post-PCI phase, to minimize bleeding risk.

What is DAPT used for?

Prevents stent thrombosis and recurrent ischemic events after PCI or ACS.

When is clopidogrel preferred as P2Y12 inhibitor?

In combination with OAC to reduce bleeding risk compared to ticagrelor or prasugrel.

What does ">12 months" imply in CCD management?

Transition to long-term maintenance with SAPT (aspirin or P2Y12) or DOAC alone depending on indication.