Dual Antiplatelet Therapy During PCI Placement

Rationale for Continuing DAPT During PCI

The American College of Cardiology and European Society of Cardiology recommend P2Y12 inhibitor therapy during PCI with a Class I, Level A recommendation, to prevent thrombotic complications during the procedure 1, 2
Discontinuation of antiplatelet therapy during PCI increases the risk of acute stent thrombosis, which carries significant morbidity and mortality 3
The European Society of Cardiology guidelines recommend continuation of P2Y12 inhibitors throughout the PCI procedure to maintain adequate platelet inhibition 4

For patients already on DAPT undergoing PCI, the American College of Cardiology recommends continuing aspirin (75-100 mg) without interruption, and continuing the P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) without interruption 1, 2, 5
For patients not previously on DAPT undergoing PCI, a loading dose of aspirin (325 mg orally or 75-250 mg IV) and a loading dose of clopidogrel (600 mg) are recommended, with prasugrel or ticagrelor considered in high-risk situations 4

For stable coronary artery disease with DES placement, the American College of Cardiology recommends 6 months of DAPT 1, 4
For patients at high thrombotic risk, the American College of Cardiology recommends extending DAPT up to 30 months 1, 2
For acute coronary syndrome, the American College of Cardiology recommends DAPT for 12 months 2

If urgent surgery is needed within 30 days of DES placement, the American Heart Association recommends continuing DAPT unless the bleeding risk significantly outweighs the benefit of stent thrombosis prevention 6
For patients on anticoagulation who require PCI, the European Society of Cardiology recommends triple therapy (DAPT plus anticoagulant) initially, followed by early cessation of aspirin and continuation of OAC plus clopidogrel 5