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. Use of DAPT alone with aspirin and clopidogrel also might be considered for patients with STEMI who have AF and low to intermediate CHADS2 scores (0 to 1), with reconsideration of the indica- tions for anticoagulation over time.296,522 The incidence of venous thromboembolic events after STEMI has declined significantly,526 though patients with HF or on prolonged bed rest remain at risk.527 The approach to the prevention and treatment of venous thromboembolic disease during hospitalization, with both pharmacological and mechan- ical measures, is similar to that for other critically ill patients.528 9.7.1.2. Heparin-Induced Thrombocytopenia HIT, with or without associated thrombosis, can infrequently particularlypatients who previously have been exposed to heparin or who receive hep- arin over several hospital days. From 1% to 5% of all patients receiving heparin will develop HIT, and of these, 25% to 50% will develop thrombotic complications. In the CATCH (Complica- tions After Thrombocytopenia Caused by Heparin) registry,530,531 thrombocytopenia was common among those who received hepa- rin for >96 hours (36.4%) and was associated with a significantly increased risk of death, MI, or HF. Recognition of HIT frequently was delayed, and treatment often did not include a direct thrombin inhibitor. Data on the use of direct thrombin inhibitors in patients with STEMI who develop HIT are limited.532,533 For patients with STEMI and HIT who require stenting, bivalirudin would be the preferred anticoagulant. Management of patients with HIT who require urgent CABG can be more difficult.534 9.7.2. 