Recommendation 37. We suggest an initial regimen of triple therapy with ASA 81 mg daily with clopidogrel 75 mg daily plus OAC. ASA may be discontinued as early as the day after PCI or it can be continued up to 6 months of treatment, depending on the risk of recurrent coronary ischemic events vs major bleeding. After ASA discontinuation, we suggest treatment with OAC plus clopidogrel 75 mg daily for up to 1 year. If there is evidence of LV thrombus resolution ≥ 3 months after PCI, we suggest discontinuation of OAC and treatment with ASA 81 mg daily plus a P2Y12 inhibitor for up to 1 year after PCI (Weak Recommendation; Very Low-Quality Evidence).
Practical tip. Warfarin is the only anticoagulant evaluated for the treatment of established LVT. Although NOACS are generally safer than warfarin, they have not been evaluated specifically in this context.
In patients who undergo PCI for an ACS indication who are at high risk of developing LV thrombus:Recommendation 38. We recommend DAPT with ASA 81 mg daily plus either ticagrelor 90 mg BID or prasugrel 10 mg once daily for up to 1 year (Strong Recommendation; Moderate-Quality Evidence).
Recommendation 39. We suggest routine use of triple therapy should be avoided because of the weak evidence for prevention of LV thrombus and higher risk of bleeding events (Weak Recommendation; Moderate-Quality Evidence).