Treatment Algorithm for Duration of P2Y12 Inhibitor Therapy in Patients With Stable Ischemic Heart Disease

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Treatment algorithm of Stable Ischemic Heart Disease

     Patients with a history of ACS > 1 year prior who have since remained free of recurrent ACS are considered to have transitioned to SIHD. Arrows at the bottom of the figure denote that the optimal duration of prolonged DAPT is not established. Clopidogrel is the only currently used P2Y12 inhibitor studied in patients with SIHD undergoing PCI. Aspirin therapy is almost always continued indefinitely in patients with coronary artery disease. 

    *High bleeding risk denotes those who have or develop a high risk of bleeding (e.g., treatment with oral anticoagulant therapy) or are at increased risk of severe bleeding complication (e.g., major intracranial surgery). ACS indicates acute coronary syndrome; BMS, bare metal stent; CABG, coronary artery bypass graft surgery; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; Hx, history; MI, myocardial infarction; PCI, percutaneous coronary intervention; SIHD, stable ischemic heart disease; and S/P, status post.  

To estimate bleeding risk, use DAPT-score. You can find it HERE 

According to 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet
Therapy in Patients With Coronary Artery Disease


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