2016 Dual antiplatelet therapy

 

Duration

Considerations:

         Risk and consequences of bleeding

         Risk of consequences of thrombosis

Hot stent (during AMI):

         DES: 12 months

         BMS: 12 months

         No stent: 2 weeks (ideal 12 months)

Cold stent (elective):

         DES: 6 months

         BMS: 1 month

Choice of drug

         Clopidogrel: default

         Ticagrelor: if resistant, or if not stenting

Risk of thrombosis

Stent:

         Multiple

         Narrow

         Long

         Bifurcated

Patient:

         Prev stent thrombosis

         Diffuse coronary disease

         ACS presentation

         Diabetes

         Heart failure

         CKD

 

If planning surgery:

Angioplasty

      Wait 2/52

Bare metal stent

      DAPT ideal 6/52

Drug-eluting stent

      DAPT absolute minimum 3 months

      Discussion: surgeon + cardiologist

Recent AMI

      Highest risk period <2/12

      Baseline risk after 6-12/12

 

 

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