Antiplatelet Therapy Management in Chronic Coronary Syndrome Requiring Non-Urgent Elective Revascularization
Introduction to Antiplatelet Therapy
- The European Society of Cardiology recommends dual antiplatelet therapy (DAPT) with aspirin 75-100 mg plus clopidogrel 75 mg daily for up to 6 months after percutaneous coronary intervention (PCI), followed by lifelong monotherapy in patients with chronic coronary syndrome requiring non-urgent elective revascularization 1, 2
Antiplatelet Strategy According to Type of Revascularization
- For elective percutaneous coronary revascularization, the initial dual antiplatelet therapy consists of aspirin 75-100 mg daily plus clopidogrel 75 mg daily for up to 6 months, regardless of the type of stent used 1, 2, 3
- In patients with high bleeding risk but no high ischemic risk, DAPT should be discontinued after 1-3 months and monotherapy continued 1, 2
Management After Revascularization
- After coronary artery bypass grafting (CABG), aspirin 75-100 mg daily is recommended for life 1, 2
- Aspirin should be initiated postoperatively as soon as there is no concern for bleeding 2
Long-Term Antiplatelet Therapy
- Lifelong monotherapy with aspirin 75-100 mg daily is recommended after the initial DAPT period in patients with previous myocardial infarction or remote PCI 1, 2
- Clopidogrel 75 mg daily is a safe and effective alternative to aspirin monotherapy in patients with previous myocardial infarction or remote PCI 1, 2
Special Considerations for Patients with Indication for Oral Anticoagulation
- In patients with an indication for oral anticoagulation (e.g., atrial fibrillation), low-dose aspirin once daily should be added to oral anticoagulation and clopidogrel 1, 2
- Direct oral anticoagulant (DOAC) is preferred over vitamin K antagonist (VKA) in eligible patients 1, 2