From the Research
For peripheral artery stents, dual antiplatelet therapy (DAPT) is typically recommended for at least 1-3 months after the procedure, followed by long-term single antiplatelet therapy, but the most recent and highest quality study suggests that dual therapy consisting of clopidogrel with rivaroxaban, apixaban, or dabigatran should be continued for 12 months, with oral anticoagulant monotherapy continued thereafter 1.
Specific Regimen:
- DAPT for 1-3 months:
- Aspirin 81-325 mg daily
- Plus clopidogrel 75 mg daily
- After 1-3 months, consider dual therapy with clopidogrel and an oral anticoagulant such as rivaroxaban, apixaban, or dabigatran for 12 months, followed by oral anticoagulant monotherapy The initial DAPT helps prevent early stent thrombosis while the stent endothelializes. The duration may be adjusted based on individual patient factors such as bleeding risk and stent location. Long-term single antiplatelet therapy or oral anticoagulant monotherapy helps maintain stent patency and reduce cardiovascular events.
Considerations:
- For patients with high bleeding risk, consider shortening DAPT to 1 month or using a dual therapy regimen with a lower bleeding risk 2.
- For those with high ischemic risk or complex lesions, DAPT or dual therapy may be extended beyond 3 months or 12 months, respectively.
- Always assess the patient's overall cardiovascular risk, bleeding risk, and any contraindications before initiating therapy. Regular follow-up is essential to monitor for complications and ensure adherence to the antiplatelet regimen.
Key Points:
- The most recent study suggests a dual therapy regimen with clopidogrel and an oral anticoagulant for 12 months, followed by oral anticoagulant monotherapy 1.
- Individual patient factors such as bleeding risk and stent location should be considered when adjusting the duration of therapy.
- Regular follow-up is essential to monitor for complications and ensure adherence to the antiplatelet regimen.