Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e383 Early Implementation of the American College of Cardiology/ American Heart Association Guidelines) study, excessive doses of UFH, LMWH, and GP IIb/IIIa inhibitors accounted Aspirin should be maintained at 81 mg per day (after initial stent implantation). Owing to excess bleeding without clinical benefit, the US Food and DrugAdministration lists a Black Box warning that does not recommend adminis- tration of prasugrel to patients with NSTE-ACS who are 75 years of age or weigh <60 kg except in those at very high risk. A metaanalysis of 6 RCTs about the use of GP IIb/IIIa inhibitors in patients with NSTE-ACS reported no significant age-treatment interaction, although older women had signifi- cantly more adverse events.549 Bivalirudin appears safer for older patients with NSTE-ACS PCI than GP IIb/IIIa inhibi- tors plus UFH, with less bleeding and similar efficacy.526,550 AF is more common in older patients with NSTE-ACS, and triple therapy (DAPT and warfarin) entails a marked bleeding In the WOEST (What is the Optimal Antiplatelet and Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary Stenting) study, it was found that in patients taking oral coagulants who required PCI, use of clopidogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in thrombotic Nonetheless, practice should not be changed on the basis of this limited study alone. 