Recommendation 29. If age < 65 years and CHADS2 = 0, we recommend long-term therapy with either ASA alone or, if high-risk clinical or angiographic features of ischemic events and low risk of bleeding, ASA with P2Y12 inhibitor (Strong Recommendation; High-Quality Evidence); or
If age is 65 years or older or CHADS2 ≥ 1 we recommend long-term therapy with either OAC alone (Strong Recommendation; Moderate- and High-Quality Evidence) or, if high-risk clinical or angiographic features of ischemic events persist and low risk of bleeding, OAC with single antiplatelet therapy with ASA or a P2Y12 inhibitor (Weak Recommendation; Low-Quality Evidence).
Practical tip. The COMPASS trial42 showed that, in patients with stable CAD or peripheral arterial disease who did not have AF, ASA used in addition to very low dose OAC (rivaroxaban 2.5 mg BID) reduced major CV events. It is important to note that rivaroxaban 2.5 mg BID has not been evaluated for long-term stroke prevention in patients with AF. The standard stroke prevention dose of rivaroxaban in patients with AF is 15 mg or 20 mg daily. Consideration could be given to extending treatment long-term with OAC (at a standard AF stroke prevention dose) and single antiplatelet therapy (clopidogrel or ASA) in selected patients at low risk of bleeding who have high-risk clinical or angiographic features for ischemic events.