A meta-analy- sis of RCTs comparing warfarin plus aspirin to aspirin alone in patients with ACS showed that in studies with an international normalized ratio goal of 2.0 to 3.0, combination therapy was associated with a significant reduction in major adverse events at the expense of an increased risk of major bleeding.521 None of the trials included patients treated with primary PCI or DAPT. Triple therapy with a vitamin K antagonist, aspirin, and a receptor inhibitor should be restricted to specific clini- cal situations after STEMI in which the risk of systemic or venous thromboembolism or stent thrombosis is considered to exceed that of bleeding. Patient preferences and values should be taken into consideration, because individuals may weigh these outcomes differently. The novel oral anticoagulants such as dabigatran have not been evaluated in this context, and thus no recommendation for their use can be made. The duration of vitamin K antagonist therapy can be limited to 3 months in patients with or at risk for LV thrombus (eg, those with antero- apical akinesis or dyskinesis), whereas the duration of DAPT could be predicated on stent type or whether STEMI treatment included a stent.219,522,523 For patients undergoing primary PCI who require anticoagulation, avoidance of a DES is strongly preferred. When triple therapy is used, an international nor- malized ratio targeted to a range of 2.0 to 2.5 might be rea- sonable, though prospective data are lacking. 