What are the 2016 ACC/AHA guidelines for the use of dual antiplatelet therapy (DAPT) in non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Key recommendations for patients with non–ST elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction(STEMI) treated with DAPT are summarized below. [134]

Class I

For all patients treated with DAPT, administer a daily aspirin dose of 81 mg (range, 75-100 mg). (Level of evidence: B-NR)

After bare-metal stent (BMS) or drug-eluting stent (DES) implantation in patients with ACS, P2Y12 inhibitor therapy (clopidogrel, prasugrel, or ticagrelor) should be given for at least 1 year. (Level of evidence: B-R)

For patients who subsequently undergo coronary artery bypass grafting (CABG) after coronary stent implantation, resume P2Y12 inhibitor therapy postoperatively to maintain DAPT until the recommended duration of therapy is completed. (Level of evidence: C-EO)

In ACS patients who undergo CABG, resume P2Y12 inhibitor therapy after CABG to complete 1 year of DAPT therapy. (Level of evidence: C-LD) 

Patients with STEMI treated with DAPT and fibrinolytic therapy should continue P2Y12 inhibitor therapy (clopidogrel) for at least 14 days (level of evidence: A) and, ideally, at least 1 year (level of evidence: C-EO).

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