|2012 Focused Update Recommendations||2012 Comments|
|1. Use of warfarin in conjunction with aspirin and/or P2Y12 receptor inhibitor therapy is associated with an increased risk of bleeding, and patients and clinicians should watch for bleeding, especially GI, and seek medical evaluation for evidence of bleeding (7,9,13,14,141–144). (Level of Evidence: A)||2011 recommendation modified (“thienopyridine” replaced with “P2Y12 receptor inhibitor”).|
|1. Warfarin either without (INR 2.5 to 3.5) or with low-dose aspirin (81 mg per day; INR 2.0 to 2.5) may be reasonable for patients at high coronary artery disease risk and low bleeding risk who do not require or are intolerant of P2Y12 receptor inhibitor therapy (145,146). (Level of Evidence: B)||2011 recommendation modified (“thienopyridine” replaced with “P2Y12 receptor inhibitor”).|
|2. Targeting oral anticoagulant therapy to a lower INR (e.g., 2.0 to 2.5) might be reasonable in patients with UA/NSTEMI managed with aspirin and a P2Y12 inhibitor. (Level of Evidence: C)||New recommendation|
GI indicates gastrointestinal; INR, international normalized ratio; and UA/NSTEMI, unstable angina/non–ST-elevation myocardial infarction.