The Living Guidelines: Oral Antiplatelet Therapy Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines

 * 1) Patients already taking daily long-term aspirin therapy should take 75 mg to 325 mg of aspirin before PCI is performed. (Class I Level of Evidence: A)
 * 2) Patients not already taking daily long-term aspirin therapy should be given 300 mg to 325 mg of aspirin at least 2 hours and preferably 24 hours before PCI is performed. (Class I Level of Evidence: C)
 * 3) After PCI, in patients without allergy or increased risk of bleeding, aspirin 162 mg to 325 mg daily should be given for at least 1 month after bare metal stent implantation, 3 months after Sirolimus eluting stent implantation, and 6 months after Paclitaxel eluting stent implantation, after which daily long-term aspirin use should be continued indefinitely at a dose of 75 mg to 162 mg. (Class I Level of Evidence: B)
 * 4) A loading dose of clopidogrel (some uncertainty exists about optimal loading dose of clopidogrel. Randomized trials establishing its efficacy and providing data on bleeding risks used a loading dose of 300 mg orally followed by a daily oral dose of 75 mg. Higher oral loading doses such as 600 mg or 900 mg of clopidogrel more rapidly inhibit platelet aggregation and achieve a higher absolute level of inhibition of platelet aggregation, but the additive clinical efficacy and safety of higher oral loading doses have not been rigorously established) generally 600 mg, should be administered before or when PCI is performed. (Class I Level of Evidence: C) In patients undergoing PCI within 12 to 24 hours of receiving fibrinolytic therapy, a clopidogrel oral loading dose of 300 mg may be considered. (Class I Level of Evidence: C)
 * 5) For all post PCI stented patients receiving a drug eluting stent (DES), clopidogrel 75 mg daily should be given for at least 12 months if patients are not at high risk of bleeding. For post PCI patients receiving a bare metal stent, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks). (Class I Level of Evidence: B)