Cardiology>>>>>Arrythmias
Question 29#

A 50-year-old man with a history of hypertension, diabetes, and persistent atrial fibrillation, for which he is warfarinized, is admitted with an NSTEMI. He undergoes PCI to his proximal LAD with a drug-eluting stent (DES).
What is the best combination of drugs following his intervention?

A) Aspirin, clopidogrel, and warfarin for  month; then warfarin alone thereafter
B) Aspirin, clopidogrel and warfarin for 1 month; then warfarin and clopidogrel for 12 months followed by warfarin alone
C) Aspirin, clopidogrel, and warfarin for 6 months; then warfarin and clopidogrel for 6 months followed by warfarin alone
D) Aspirin, clopidogrel and warfarin for 12 months; then warfarin alone
E) Aspirin and warfarin for 12 months; then clopidogrel alone

Correct Answer is C

Comment:

This man has CHADS2 and CHA2DS2VASc scores of 2 and is already warfarinized prior to his NSTEMI. He has a HAS-BLED score of 1 (one point for hypertension) and thus is at low risk of bleeding. The ESC guidelines suggest that a patient with a low or intermediate risk of bleeding who undergoes PCI in the context of ACS (with either BMS or DES) should receive 6 months triple therapy of warfarin + aspirin + clopidogrel, with up to 12 months warfarin and clopidogrel (or aspirin) with PPI cover followed by warfarin alone thereafter.