ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)
Writing Committee Members, Elliott M. Antman, Daniel T. Anbe, Paul Wayne Armstrong, Eric R. Bates, Lee A. Green, Mary Hand, Judith S. Hochman, Harlan M. Krumholz, Frederick G. Kushner, Gervasio A. Lamas, Charles J. Mullany, Joseph P. Ornato, David L. Pearle, Michael A. Sloan, Sidney C. Smith Jr, Task Force Members, Elliott M. Antman, Sidney C. Smith Jr, Joseph S. Alpert, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Raymond J. Gibbons, Gabriel Gregoratos, Jonathan L. Halperin, Loren F. Hiratzka, Sharon Ann Hunt, Alice K. Jacobs and Joseph P. Ornato
Long-term antithrombotic therapy at hospital discharge after STEMI. ASA indicates aspirin; LOE, level of evidence LV, left ventricular; and INR, international normalized ratio. *Clopidogrel is preferred over warfarin because of increased risk of bleeding and low patient compliance in warfarin trials. †For 12 months. ‡Discontinue clopidogrel 1 month after implantation of a bare metal stent or several months after implantation of a drug-eluting stent (3 months after sirolimus and 6 months after paclitaxel) because of the potential increased risk of bleeding with warfarin and 2 antiplatelet agents. Continue aspirin and warfarin long term if warfarin is indicated for other reasons such as atrial fibrillation, LV thrombus, cerebral emboli, or extensive regional wall-motion abnormality. §An INR of 2.0 to 3.0 is acceptable with tight control, but the lower end of this range is preferable. The combination of antiplatelet therapy and warfarin may be considered in patients aged less than 75 years with low bleeding risk who can be monitored reliably.