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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168 August 29, 2023 Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline therapy and standard dose DOACs for reducing stroke risk among patients with atrial fibrillation (dabigatran 150 mg twice daily, apixaban 5 mg twice daily, rivaroxaban 20 mg daily, edoxaban 60 mg daily) is not without added bleeding risk. The variability in treatment duration, as well as various platelet adenosine diphosphate receptor (P2Y12) agents and DOAC regimens tested in these trials highlights the need for an individualized approach to achieve the optimal balance between ischemic and bleeding risks. Although DES are the predominant stent used in the United States, bare metal stents are still used in a small proportion of patients. The reader is referred to the 2016 AHA/ACC guideline for DAPT34 for specific treatment details for bare metal stents. Recommendation-Specific Supportive Text 1 The use of aspirin for secondary ASCVD preven- tion is well established for reduction in MACE.2,45 More recently, the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long- Term) trial used a large (N=15 076), open-label design to assign patients with established ASCVD to either 81 mg or 325 mg of aspirin.3 No significant differences were observed in the primary composite of death from any cause, hospitalization for MI, or hospitalization for stroke by aspirin dose. No differences in major bleeding were observed. However, substantial dose switching was observed (41.6% of patients assigned to take 325 mg daily switched to 81 mg daily and 7.1% assigned to take 81 mg daily switched to 325 mg daily). As an alternative to low-dose aspirin, clopidogrel may be used in individuals who cannot tolerate aspirin therapy, and many of the contemporary trials have used clopidogrel monotherapy after a short course of DAPT.46,47 2. To assess optimal duration of antiplatelet therapy, a meta-analysis of RCTs (n=31 666 patients) comparing shorter DAPT with longer DAPT Figure 9. Recommended Duration of Antiplatelet Therapy.*† ACS indicates acute coronary syndrome; ASA, aspirin; CCD, chronic coronary disease; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; DOAC, direct oral anticoagulant; MI, myocardial infarction; OAC, oral anticoagulants; PCI, percutaneous coronary intervention; SAPT, single antiplatelet therapy. *Colors correspond to Class of Recommendation in Table 3. †This figure does not encompass all recommendations within this section. Downloaded from http://ahajournals.org by on October 7, 2026