Antithrombotic Therapy After Coronary Stenting
Initial Therapy After Stent Placement
- The European Society of Cardiology recommends dual antiplatelet therapy (DAPT) with aspirin and clopidogrel after stent placement, with aspirin 325 mg daily for at least 1 month after bare-metal stent placement, 3 months after sirolimus-eluting stent placement, and 6 months after paclitaxel-eluting stent placement 1, 2
- The American Heart Association recommends clopidogrel 75 mg daily for at least 1 month after bare-metal stent placement, 3 months after sirolimus-eluting stent placement, and 6 months after paclitaxel-eluting stent placement 1, 2
Long-term Therapy
- The European Society of Cardiology recommends lifelong aspirin therapy at a dose of 75-100 mg daily after the initial DAPT period 3, 4
- The American College of Cardiology recommends clopidogrel 75 mg daily as a safe and effective alternative to aspirin in patients who are intolerant to aspirin 3
Special Clinical Situations
- In patients with a high risk of bleeding, a lower dose of aspirin (75-162 mg) may be used even in the initial period after stent placement 1, 2
- For patients requiring warfarin in combination with aspirin and/or clopidogrel, careful monitoring of the increased risk of bleeding is recommended 1, 2
- For patients requiring triple therapy (warfarin, clopidogrel, and aspirin), a target INR of 2.0-2.5 with low-dose aspirin (75-81 mg) is recommended 1, 2
- After acute coronary syndrome or percutaneous coronary intervention with stent placement, DAPT (aspirin + P2Y12 receptor antagonist) is recommended for at least 12 months 4
Important Aspects and Precautions
- When nonsteroidal anti-inflammatory drugs (NSAIDs) are required for patients with cardiac stents, acetaminophen (paracetamol) is the safest first-line option due to its lack of significant cardiovascular effects 5
- Non-selective NSAIDs should be avoided whenever possible in patients with cardiac stents due to the increased risk of adverse cardiovascular events 5