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| Clinical Scenarios | Recommendations |
|
| Coronary artery disease stented with first generation bare metal stent | Dual antiplatelets for 4-12 weeks [30] |
|
| Coronary artery disease stented with first generation drug eluting stent | Dual antiplatelet for ≥ 12 months [30] |
|
| Transplant surgery | Transplant surgery within 3 months of bare metal stent and within 12 months of drug eluting stent should not be performed [30] |
|
| Stable coronary artery disease stented with newer-genration (everolimus / zotarolimus) drug eluting stents | Dual antiplatelet therapy for 6 months [31–33] |
|
| Coronary artery disease stented with low risk of bleeding and having newer-genration (everolimus / zotarolimus) drug eluting stents or bare metal stent | Guidelines recommend continuation of dual antiplatelet beyond 1 month in baremetal stent and more than 6 months in drug eluting stent in patients who are at low risk of bleeding [33]. |
|
| Coronary artery disease stented with high risk of bleeding and having newer-genration (everolimus / zotarolimus) drug eluting stents or bare metal stent | Discontinuation of P2Y12 inhibitor therapy after 3 months may be reasonable in those with high risk of bleeding |
|
| Patient with acute coronary syndrome (NSTEMI / STEMI) treated baremetal stent or newer generation drug eluting stent | Dual antiplatelet should be given for atleast 12 months [33–35] |
|
| Patients with acute coronary syndrome treated with stenting, who has tollerated dual antiplatelets without a bleeding complication, and who are not at high risk of bleeding | Continuation of dual antiplatelets beyond 12 month may be reasoable [33] |
|
| Patients with acute coronary syndrome treated with stenting and at high risk of bleeding | Discontinuation of P2Y12 inhibitor after 6 months may be reasonable [33] |
|
| Patients with ACS who never underwent revascularization or fibrinolytic therapy | They should be treated with dual antiplatelets for at least 12 months [33, 34, 36]. |
|
| ST elevated myocardial infarction | Should be continued on dual antiplatlet for a minimum period of 14 days [33, 36] and ideally at least 12 months [33]. |
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| Patients planning for transplantation in one year and needing PCI | Angioplasty with bare metal stenting followed by 4-12 weeks of dual antiplatelets [30]. |
|
| KTR on dual antiplatelets needing emergency surgery | Hold thienopyridine for 5 days and continuing aspirin preoperatively [30, 33].Thienopyridine, may be started as early as possible after the surgery [30, 33]. |
|
| Waiting time for kidney transplantation and other elective surgery after PCI | Wait for 3 months in case of bare metal stenting and 6 months for drug eluting stenting [33, 37–39]. |
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| Dose of aspirin | The recommended dialy dose for aspirin is 81 mg (range, 75 to 100 mg) for prevention of secondary prophylaxis [33, 40] |
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| Proton pumpinhibitors | Proton pump inhibitors (PPIs) are recommended in patients with dual antiplatelets with increased risk of bleeding. This includes advance age, concomitant use of warfarin or non steroidal antiinflammatory drugs (class 2a evidence). Routine use of PPIs in patients at low risk of bleeding is not recommended (class III, no benefits) [33]. |
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