ACC/AHA 2016: DAPT Update

Question 1

If DES and low-risk (non-ACS), what duration of DAPT is best?

Answer 1

If a newer generation DES (everolimus or zotarolimus), can do 3 - 6 months instead of longer therapy

Question 2

How long should aspirin therapy be in CAD patients?

Answer 2

Lifelong

Question 3

Some factors associated with increased bleeding risk

Answer 3

Female, low body weight, advanced age, history of prior bleeding, CKD, DM, anemia

Question 4

If ACS, stented, and then DAPT, drug of choice for DAPT

Answer 4

Ticagrelor > Clopidogrel
+
ASA

Question 5

If NSTE-ACS without revascularization, drug of choice for DAPT

Answer 5

Ticagrelor > Clopidogrel
+
ASA

Question 6

Avoid Prasugrel if

Answer 6

History of stroke or TIA
Weight < 60 mg
Age >/= 75 years
not doing PCI

Question 7

If ACS, stented, low/moderate bleed risk, no history of stroke or TIA, can use

Answer 7

Prasugrel over Clopidogrel

Question 8

P2Y12 inhibitor for triple therapy

Answer 8

Clopidogrel

Question 9

If stable ischemic heart disease treated with DAPT after BMS implantation, give this P2Y12 inhibitor for this duration

Answer 9

Clopidogrel for 1 month minimum

If not at high risk for bleeding and have tolerated DAPT without a bleeding complication, longer than 1 month may be reasonable

Question 10

If stable ischemic heart disease treated with DAPT after DES, give this P2Y12 inhibitor for this duration

Answer 10

Clopidogrel for 6 months

If not at high risk for bleeding and have tolerated DAPT without a bleeding complication, longer than 6 months may be reasonable

Question 11

If stable ischemic heart disease treated with DAPT after DES who develop a high risk for bleeding or significant overt bleeding, it is reasonable to

Answer 11

Discontinue P2Y12 inhibitor after 3 months

Question 12

Duration of time on P2Y12 inhibitor for patients with ACS after BMS/DES implantation treated with DAPT

Answer 12

At least 12 months

Question 13

In ACS treated with DAPT after coronary stent implantation, reasonable P2Y12 inhibitor of choice

Answer 13

Ticagrelor > Clopidogrel

Question 14

In ACS treated with DAPT after coronary stent implantation who are not at high risk for bleeding and do not have a history of stroke or TIA, reasonable P2Y12 inhibitor of choice

Answer 14

Prasugrel > Clopidogrel

Question 15

In ACS treated with DAPT after DES who develop a high risk for bleeding or overt bleeding, it is reasonable to

Answer 15

Discontinue P2Y12 inhibitor after 6 months

Question 16

In DAPT after stent who undergo CABG, should DAPT be resumed post-op?

Answer 16

Yes

Question 17

If SIHD on DAPT and then undergo CABG, reasonable duration of DAPT therapy

Answer 17

12 months

Question 18

When to not use DAPT in SIHD

Answer 18

if no stent, no ACS history, and no CABG within 12 months

Question 19

If ACS managed with medical therapy alone (no revascularization or fibrinolytic therapy), duration of DAPT

Answer 19

12 months

Reasonable to treat for longer if not high bleeding risk and no bleeding complication

Question 20

If STEMI + fibrinolytic, duration of clopidogrel therapy

Answer 20

Minimum 14 days, and ideally, at least 12 months

Question 21

If BMS implantation, how long should elective noncardiac surgery be delayed?

Answer 21

30 days after BMS implantation

Question 22

If DES implantation, how long should elective noncardiac surgery be delayed?

Answer 22

6 months after DES implantation ideally

Question 23

If P2Y12 must be held for a surgery, recommend

Answer 23

restarting P2Y12 as soon as possible after surgery

continue aspirin if possible throughout the surgery

Question 24

If DES implantation and having elective noncardiac surgery, and the risk of delaying surgery is greater than the risk of stent thrombosis, how early after DES can patient get the surgery?

Answer 24

3 months after DES implantation