Antiplatelet Therapy for Patients Undergoing Angiography

Introduction to Antiplatelet Therapy

The American Heart Association recommends continuing single antiplatelet therapy (aspirin 75-100 mg daily) for patients undergoing diagnostic angiography who are already on it for established coronary disease 1.
The American College of Cardiology suggests that no antiplatelet therapy is required for patients undergoing diagnostic angiography who have no established coronary artery disease and are not proceeding to percutaneous coronary intervention (PCI) 2.

For patients with established coronary artery disease undergoing diagnostic angiography, the European Society of Cardiology recommends continuing existing single antiplatelet therapy (aspirin 75-100 mg daily or clopidogrel 75 mg daily) 3.
The American Heart Association advises against initiating antiplatelet therapy in patients undergoing diagnostic angiography without established coronary artery disease or PCI 2.

For Acute Coronary Syndrome (ACS) patients undergoing PCI, the American College of Cardiology recommends initiating dual antiplatelet therapy (DAPT) immediately with a loading dose of aspirin 160-325 mg plus either ticagrelor 180 mg or prasugrel 60 mg (preferred over clopidogrel 600 mg) 1.
The European Society of Cardiology suggests that ticagrelor or prasugrel is strongly preferred over clopidogrel in ACS patients undergoing PCI to reduce major adverse cardiovascular events 1.
For maintenance regimen, the American Heart Association recommends ticagrelor 90 mg twice daily (preferred) or clopidogrel 75 mg daily, plus aspirin 75-100 mg daily for 12 months minimum 1.

For elective PCI with drug-eluting stent (DES), the American College of Cardiology recommends DAPT with aspirin 75-325 mg daily plus clopidogrel 75 mg daily for the first 3-6 months 3.
After 3-6 months, the European Society of Cardiology suggests continuing DAPT with low-dose aspirin 75-100 mg daily plus clopidogrel 75 mg daily 3.
For elective PCI with bare-metal stent (BMS), the American Heart Association recommends DAPT with aspirin 75-325 mg daily plus clopidogrel 75 mg daily for the first month 3.

The American College of Cardiology recommends adding a proton pump inhibitor (PPI) to all patients on DAPT to reduce gastrointestinal bleeding risk 1.
The European Society of Cardiology suggests using radial artery access (not femoral) during PCI to reduce bleeding, vascular complications, and mortality 1.
The American Heart Association advises keeping aspirin dose at 75-100 mg daily during maintenance phase (after initial loading) to minimize bleeding while maintaining efficacy 3.

For patients with high bleeding risk (PRECISE-DAPT score ≥25), the American College of Cardiology recommends considering shorter DAPT duration (6 months or less), then transitioning to single antiplatelet therapy 5.
The European Society of Cardiology suggests avoiding prasugrel in patients with prior stroke or TIA (contraindicated) 5.
For dental procedures, the American Heart Association recommends not interrupting antiplatelet therapy as bleeding risk is minimal with local hemostatic measures 7.
In ACS patients who have tolerated DAPT with ticagrelor, the American College of Cardiology recommends transitioning to ticagrelor monotherapy (discontinue aspirin) ≥1 month after PCI as an alternative bleeding reduction strategy 1.