Critical Patient Education After Coronary Stent Placement

Dual Antiplatelet Therapy (DAPT) Guidelines

The American College of Cardiology recommends that patients must understand that stopping their antiplatelet medications prematurely can cause fatal stent thrombosis, heart attack, or death, and they should never discontinue these medications without first contacting their cardiologist 1, 2, 3
Patients must be explicitly instructed before hospital discharge to contact their treating cardiologist before stopping any antiplatelet therapy, even if another healthcare provider instructs them to stop, to prevent stent thrombosis, which results in death or myocardial infarction in 64.4% of cases, with mortality rates ranging from 20-45% 3, 2
Abrupt discontinuation of antiplatelet therapy dramatically increases the risk of stent thrombosis, with a study showing 6 of 7 patients who stopped their thienopyridine before surgery within 90 days of stent placement died in a manner suggestive of stent thrombosis 4

For bare-metal stents, the American College of Cardiology recommends DAPT with aspirin and clopidogrel must be taken for at least 1 month, and after 1 month, aspirin should be continued indefinitely at 75-162 mg daily 1, 5
For drug-eluting stents (DES), DAPT must be taken for a minimum of 12 months if the patient is not at high bleeding risk, with the American College of Cardiology recommending ideally up to 12 months for all DES types 6, 1, 2
Aspirin should be taken at 75-325 mg daily, with lower doses of 75-162 mg preferred for long-term use due to fewer bleeding complications, and clopidogrel should be taken at 75 mg daily, as recommended by the American College of Cardiology 5, 6

The American College of Cardiology recommends that all elective surgical procedures should be postponed until 12 months after DES implantation, and for bare-metal stents, elective surgery should be delayed for at least 1 month 6, 1, 3
If surgery absolutely cannot be deferred and must occur before 12 months, aspirin should be continued during the perioperative period if at all possible, and the P2Y12 inhibitor should be restarted as soon as possible after the procedure, as recommended by the American College of Cardiology 6, 3
Minor dental procedures can likely be performed without stopping antiplatelet medications, as studies show no statistically significant difference in postoperative bleeding, according to the American College of Cardiology 3, 4

Patients should be aware of warning signs requiring immediate medical attention, including new or worsening chest pain, shortness of breath, sweating, nausea, or lightheadedness accompanying chest discomfort, as recommended by the American College of Cardiology 7
Unusual bruising or bleeding that doesn't stop with pressure, black or bloody stools, blood in urine, or coughing up blood are signs of bleeding complications, according to the American College of Cardiology 4

The American College of Cardiology recommends that patients should continue all prescribed antianginal medications and statins, and enrollment in cardiac rehabilitation programs enhances patient education and compliance with the medical regimen 7
Regular follow-up appointments with the cardiologist are essential to monitor for complications and adjust medications as needed, and patients should carry a card or wear medical alert identification stating they have a coronary stent and the date of implantation, as recommended by the American College of Cardiology 3, 7