This handout is for chronic coronary / ascvd secondary prevention. Your care team identified this based on: prior mi / pci / cabg (acc/aha 2022).
Other reasons your team may use this plan: stable angina / chronic coronary syndrome (acc/aha 2022); pad or carotid disease (ascvd broader) (acc/aha 2022); premature cad family history (risk reclassification) (acc/aha 2022).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 81 mg | PO | once daily | SAPT cornerstone — irreversible COX-1/TxA2 platelet inhibition ~95%, steady-state 5–7 d; ATT secondary-prevention serious-vascular-event ↓~20%. Lifelong unless a defined DAPT/DPI window (2023 CCD Class I, PMID 37471501) |
| clopidogrel | 75 mg | PO | once daily | DAPT × 6–12 mo post-PCI; P2Y12 ~40–60% inhibition (CYP2C19-dependent), onset 2 h with 300–600 mg load. As SAPT monotherapy when ASA-intolerant: CAPRIE composite RRR 8.7% (95% CI 0.3–16.5) vs ASA (PMID 8918275) |
| ticagrelor | 60 mg BID (extended DAPT) or 90 mg BID (≤1 y post-ACS) | PO | BID | Reversible P2Y12 ~80–90% inhibition, onset 30 min–2 h. PEGASUS-TIMI 54 60 mg BID beyond 1 y: CV death/MI/stroke HR 0.84 (0.74–0.95), TIMI major bleed 2.30 vs 1.06% (PMID 25773268) |
| prasugrel | 10 mg (5 mg if <60 kg or ≥75 y) | PO | once daily | Irreversible P2Y12 ~80% inhibition; post-PCI ACS DAPT. Contraindicated with prior stroke/TIA (net-harm signal) |
| rivaroxaban | 2.5 mg BID + ASA 81 mg | PO | BID | COMPASS dual-pathway (vascular dose): MI/stroke/CV death HR 0.74 (0.65–0.86), all-cause death HR 0.77 (0.65–0.90), major bleed HR 1.66 (1.37–2.03) vs ASA alone (PMID 29132879) |
Plan: 2023 AHA/ACC CCD + 2026 Dyslipidemia — secondary-prevention bundle (5 pillars, stepwise)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiac rehab referral, vaccination (flu/pneumococcal/COVID), lifestyle, AAA screening if eligible (ACC/AHA 2022)
Guideline: 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline (PMID 37471501, DOI 10.1161/CIR.0000000000001168) + 2026 ACC/AHA Multisociety Dyslipidemia Guideline (PMID 41824590/41824552) + 2019 AHA/ACC Primary Prevention (PMID 31613350) + 2025 AHA/ACC HBP + ADA SoC 2026