Table 4

Double therapy (OAC+SAPT)

IndicationTherapyDuration of double therapyGuideline
Indication for therapeutic anticoagulation and ACS <1 yearOAC+ASA or clopidogrel12 months after ACS*†, followed by OAC therapy‡2017 ESC focused update on dual antiplatelet therapy in coronary artery disease.9
Indication for therapeutic anticoagulation and PCI <1 yearOAC+ASA or clopidogrel6–12 months after PCI*†, followed by OAC therapy‡2017 ESC focused update on dual antiplatelet therapy in coronary artery disease.9
2018 ESC/EACTS Guidelines on myocardial revascularisation.17
Indication for therapeutic anticoagulation and TAVI procedure <3–6 months agoOAC+ASA3–6 months, followed by OAC therapy†*2017 ESC/EACTS Guidelines for the management of valvular heart disease.10
Indication for therapeutic anticoagulation and aortic bioprosthesis or valve sparing <3 monthsOAC+ASA3 months, followed by OAC therapy†*2017 ESC/EACTS Guidelines for the management of valvular heart disease.10
Indication for therapeutic anticoagulation and carotid artery stenting
<1–6 months ago
OAC+ASAAt least 1 month, optimal duration is not known. In research setting until 6 months. Followed by OAC therapy†*2011 Society for vascular surgery Guidelines for management of extracranial carotid diasease.13
Indication for therapeutic anticoagulation and endovascular revascularisation (stent/graft)OAC+ASA or clopidogrelAt least 1 month, optimal duration is not known. Followed by OAC therapy†*2017 ESVS/ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases.11,12
  • *Treatment can be extended in patients with high ischaemic risk and in patients with mechanical prosthesis and atherosclerotic disease.

  • †Shorter duration may be considered in patients with a high bleeding risk.

  • ‡Unless the therapeutic anticoagulation therapy is stopped, in which case ASA or clopidogrel should be started.

  • ACS, acute coronary syndrome; ASA, acetylsalicylic acid; EACTS, European Society of Cardio-Thoracic Surgery; ESC, European Society of Cardiology; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; TAVI, transcatheter aortic valve implantation.