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CLINICAL STATEMENTS AND GUIDELINES

April 1, 2025 Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 e826

11 DISCHARGE: LONG-TERM

MANAGEMENT AND SECONDARY PREVENTION

11.1 DAPT Strategies in the First 12 Months

Postdischarge Recommendations for DAPT Strategies in the First 12 Months Postdischarge Referenced studies that support recommendations are summarized in the Evidence Table. COR LOE Recommendations Default Duration of DAPT

1 A 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.1–6 Bleeding Reduction Strategies

1 A 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.7–11

1 A 3 In patients at high risk of gastrointestinal

bleeding, a proton pump inhibitor (PPI) is recommended in combination with DAPT, oral anticoagulants, or both to reduce risk of bleeding.12–15

2b B-R 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.16–20

2b B-R 5 In patients with ACS undergoing PCI who are at

high bleeding risk, transition to single antiplatelet therapy (aspirin or P2Y12 inhibitor) after 1 month may be reasonable to reduce bleeding risk.21

Figure 10. Core Components of Cardiac Rehabilitation. Adapted with permission from Sandesara et al.30 Copyright 2015 American College of Cardiology Foundation.

Recommendations for DAPT Strategies in the First 12 Months Postdischarge (Continued) COR LOE Recommendations

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