7. Post Myocardial Infarction Recommendations

Anti-platelet therapy

  • Antiplatelet therapy with low dose aspirin (75-100mg) is recommended indefinitely after myocardial infarction (MI).
  • In patients with true aspirin intolerance, clopidogrel 75 mg should be considered as an alternative.
  • More potent anti-platelet agents (such as prasugrel or ticagrelor) are recommended as dual anti-platelet therapy in combination with aspirin in patients with acute coronary syndromes.
  • Dual antiplatelet therapy is recommended for up to 12 months post MI with a minimum of
    • 1 month for patients also receiving a bare metal stent
    • 6 months for patients also receiving a drug eluting stent

Lipid lowering therapy

  • Intensive statin therapy is recommended in all patients following MI in the absence of a contraindication or intolerance, irrespective of initial cholesterol values.
  • Statins should be prescribed with a ‘lower is better’ approach to achieve levels of at least <2.5 mmol/L for non-HDL-c (equivalent to <1.8 mmol/L for LDL-cholesterol).

Beta blockers, ACE inhibitors/ARBs, aldosterone antagonists

  • Use of beta blockers, ACE inhibitors/ARBs and aldosterone antagonists post MI is recommended in line with existing NICE, SIGN and ESC guidance.