Abstract
Routine pretreatment with a P2Y12 receptor inhibitor is not recommended in patients with NSTE-ACS and planned early invasive treatment. Dual antiplatelet therapy (DAPT) consisting of a potent P2Y12 receptor inhibitor together with acetylsalicylic (ASA) is recommended for 12 months regardless of the type of stent unless contraindications are present.
De-escalation and adjustment of DAPT time may be performed with respect to ischemic and bleending risk. When triple antithrombotic therapy (TAT) is required, novel oral anticoagulants (NOAC) at the dose recommended for the prevention of stroke is preferred for safety over vitamin K antagonist.
After intial 1 -week TAT treatment with ASA + clopidogrel + NOAC, it is recommended to continue clopidogrel + NOAC for 12 months. If the ischemic risk outweighs, the risk of bleeding, the TAT can be extended up to one month.