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ACS with AF — RACP Adult Medicine MCQ

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HardCardiologyACS with AFRACP Adult Medicine

A 60-year-old man with an ACS undergoes PCI with drug-eluting stent placement. He also has AF requiring long-term anticoagulation with apixaban. According to the 2025 Australian ACS guideline, which combination is recommended for the initial period?

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Correct answer: B — Aspirin + clopidogrel + apixaban (triple therapy)

The 2025 Australian ACS guideline recommends aspirin + clopidogrel + DOAC (triple therapy) for an initial period, then step-down to clopidogrel + DOAC. Aspirin + clopidogrel is the preferred DAPT combination when combined with anticoagulation. A PPI should be co-prescribed. Duration of triple therapy is guided by ischaemic vs bleeding risk.

Reference: NHF/CSANZ – 2025 – Australian Clinical Guideline for Diagnosing and Managing ACS