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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