Dual Antiplatelet Therapy for Chronic Coronary Syndrome

Standard Dosing Regimen

The European Society of Cardiology recommends aspirin 75-100 mg once daily for patients with chronic coronary syndrome 1
The European Society of Cardiology recommends clopidogrel 75 mg once daily for patients with chronic coronary syndrome 1

For patients with chronic coronary syndrome without indication for oral anticoagulation, the European Society of Cardiology recommends dual antiplatelet therapy with aspirin 75-100 mg and clopidogrel 75 mg daily for up to 6 months 1, 2
For patients at high bleeding risk but not high ischemic risk, the European Society of Cardiology recommends discontinuing dual antiplatelet therapy after 1-3 months and continuing single antiplatelet therapy 1
For patients who are neither at high bleeding risk nor high ischemic risk, the European Society of Cardiology recommends considering stopping dual antiplatelet therapy after 1-3 months 2

The European Society of Cardiology recommends aspirin 75-100 mg daily lifelong after the initial dual antiplatelet therapy period for patients with prior MI or remote PCI 1, 3
The European Society of Cardiology recommends clopidogrel 75 mg daily as a safe and effective alternative to aspirin monotherapy for patients with prior MI or remote PCI 1, 3

For patients with enhanced ischemic risk, the European Society of Cardiology recommends considering adding a second antithrombotic agent to aspirin for extended long-term secondary prevention 1
For patients with indication for oral anticoagulation, the European Society of Cardiology recommends early cessation of aspirin (≤1 week) followed by dual therapy with OAC and clopidogrel for up to 6 months (or up to 12 months if high ischemic risk), then OAC alone 1, 4, 5
The European Society of Cardiology recommends DOAC over VKA when eligible for patients with indication for oral anticoagulation 6, 5

The European Society of Cardiology recommends a proton pump inhibitor for patients at increased risk of gastrointestinal bleeding during combination antithrombotic therapy 6
The European Society of Cardiology notes that omeprazole and esomeprazole inhibit CYP2C19 and reduce exposure to clopidogrel's active metabolite 1