Double therapy (OAC+SAPT)
| Indication | Therapy | Duration of double therapy | Guideline |
| Indication for therapeutic anticoagulation and ACS <1 year | OAC+ASA or clopidogrel | 12 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 year | OAC+ASA or clopidogrel | 6–12 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 ago | OAC+ASA | 3–6 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 months | OAC+ASA | 3 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+ASA | At 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 clopidogrel | At 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.