Acute coronary syndrome Long-term management and secondary prevention
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Acute Coronary Syndrome Chapters |
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AHA/ACC Guidelines for Acute Coronary Syndrome |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Template:Basir Afzaal Gill, M.B.B.S, M.D.
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients with Acute Coronary Syndromes
Recommendation for DAPT strategies in the First 12 Months Postdischarge
| Class I |
| Default duration of DAPT |
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"1. In patients with ACS who are not at high bleeding risk, DAPT with aspirin and an oral P2Y12 inhibitor should be administered for at least 1 year to reduce MACE. (Level A)" |
| Bleeding Reduction Strategies |
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"2. In patients with ACS who have tolerated DAPT with ticagrelor, transition to ticagrelor monotherapy ≥1 month post PCI is useful to reduce bleeding risk. (Level A)" |
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"3. In patients at high risk of gastrointestinal bleeding, a proton pump inhibitor (PPI) is recommended in combination with DAPT, oral anticogulants, or both to reduce risk of bleeding. (Level A)" |
| Class IIb |
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"4. In patients with ACS undergoing PCI, de-escalation of DAPT (switching from ticagrelor or prasugrel to clopidogrel) after 1 month may be reasonable to reduce bleeding risk. (Level B-R)" |
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"5. In patients with ACS undergoing PCI who are at high bleeding risk, transition to single antiplatelet therapy (aspirin or P2Y12 inhibitors) after 1 month may be reasonable to reduce bleeding risk. (Level B-R)" |
Recommendation for Antiplatelet therapy in Patients on Anticoagulation Postdischarge
| Class I |
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"1. In patients with ACS who require oral anticoagulant therapy, aspirin should be discontinued after 1 to 4 weeks of triple antithrombotic therapy, with continued use of P2Y12 inhibitor (preferably clopidogrel) and an oral anticoagulant to reduce bleeding risk. (Level B-R)" |
Recommendation for Reassessment of Lipid Levels Postdischarge
| Class I |
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"1. In patients after ACS, a fasting lipid panel is recommended 4 to 8 weeks after initiation or dose adjustment of lipid-lowering therapy to assess response or adherence to therapy. (Level C-LD)" |
Recommendation for Use of Chronic Colchicine
| Class IIb |
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"1. In patients after ACS, low-dose colchicine may be reasonable to reduce risk of MACE. (Level B-R)" |
Recommendation for Immunization
| Class IIb |
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"1. In patients with ACS without a contraindication, annual influenza vaccination is recommended to reduce the risk of death and MACE. (Level A)" |
- ↑ 1.0 1.1 1.2 1.3 1.4 "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 151 (13): e771–e862. 2025. doi:10.1161/CIR.0000000000001309.