Table 3.11-4. Long-term postdischarge pharmacotherapy as secondary prevention in patients with acute coronary syndrome

Agent and dosage


ASA 70-100 mg/d

Lifelong in all patients unless contraindicated

Clopidogrel 75 mg once daily


Ticagrelor 90 mg bid


Prasugrel 10 mg once daily

– Lifelong in patients with ASA contraindications or intolerance

– Combined with ASA for 12 months after ACS


– Combined with ASA for 12 months after ACS


 – Combined with ASA for 12 months after ACS


– All patients after UA/NSTEMI with LV dysfunction unless contraindicated

– All patients after STEMI unless contraindicated


– Patients after UA/NSTEMI with heart failure, LV dysfunction (LVEF <40%), hypertension, diabetes mellitus, or chronic kidney disease. Consider in all other patients as prevention of further ischemic events

– All patients after STEMI


All patients (unless contraindicated) regardless of baseline cholesterol levels. Target LDL-C <1.8 mmol/L or 70 mg/dL (<1.4 mmol/L [55 mg/dL] according to ESC guidelines)


All patients who do not tolerate ACEI, and particularly those with heart failure and LV dysfunction (LVEF <40%)


Patients after MI treated with beta-blockers and ACEI with LVEF <40% and with diabetes mellitus or heart failure but without significant renal dysfunction or hyperkalemia

Based on Eur Heart J. 2016;37(3):267-315 and Eur Heart J. 2018;39(2):119-177.

ACEI, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin-receptor blocker; ASA, acetylsalicylic acid; bid, 2 times a day; ESC, European Society of Cardiology; LDL-C, low-density lipoprotein cholesterol; LV, left ventricle; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MRA, mineralocorticoid receptor antagonist; NSTEMI, non–ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.