From the Guidelines
After having a cardiac stent placed 10 years ago, a person should typically be on antiplatelet therapy, specifically low-dose aspirin (75-100 mg daily) indefinitely, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1. While dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor like clopidogrel) is usually prescribed for 6-12 months after stent placement, most patients return to aspirin monotherapy after this period. Additionally, other medications are often recommended to manage underlying coronary artery disease, including statins to lower cholesterol, and possibly beta-blockers or ACE inhibitors/ARBs depending on the patient's specific cardiac function and comorbidities. These medications help prevent stent restenosis, reduce the risk of future cardiac events, and address the underlying atherosclerotic disease process. However, the exact medication regimen should be personalized based on the individual's specific cardiac history, stent type, risk factors, and overall health status, so regular follow-up with a cardiologist is essential to adjust medications as needed over time, as also suggested by previous guidelines 1. Some key points to consider include:
- Aspirin dose: 75-100 mg daily, as recommended by the 2024 ESC guidelines 1
- Dual antiplatelet therapy duration: at least 6 months, but can be extended up to 12 months or more, depending on the patient's risk factors and cardiac history 1
- Statin therapy: to lower cholesterol and reduce the risk of future cardiac events 1
- Beta-blocker and ACE inhibitor/ARB therapy: to manage underlying cardiac function and comorbidities, such as hypertension and heart failure 1
From the Research
Medications after Cardiac Stent Placement
- The medications a person should be on after having a cardiac stent placed 10 years ago depend on various factors, including the type of stent, the patient's medical history, and the presence of any complications.
- According to the study 2, dual anti-platelet therapy (aspirin and clopidogrel) is recommended for 12 months after drug-eluting stent percutaneous coronary intervention (DES PCI).
- The study 3 suggests that aspirin should be continued indefinitely, and a P2Y12 inhibitor (such as clopidogrel) should be administered for 12 months after PCI, unless the patient is at high risk for bleeding.
- The study 4 found that the combination of clopidogrel and low-dose aspirin for 12 months is the preferred regimen for the prevention of stent thrombosis and cardiac complications after DES placement.
- The study 5 compared aspirin vs P2Y12 inhibitor monotherapy after dual antiplatelet therapy discontinuation in patients undergoing percutaneous coronary intervention (PCI) and found that P2Y12 inhibitor monotherapy was associated with a significantly lower risk for myocardial infarction and similar risk for major bleeding.
- The study 6 found that short-term dual antiplatelet therapy with continuation of either aspirin or P2Y12 inhibitor reduced bleeding without increasing ischemic outcomes when compared with long-term DAPT.
Recommended Medications
- Aspirin: should be continued indefinitely, with a low dose (75-100 mg daily) preferred over higher doses 3.
- P2Y12 inhibitor (such as clopidogrel): should be administered for 12 months after PCI, unless the patient is at high risk for bleeding 3.
- Alternative options: P2Y12 inhibitor monotherapy may be considered after dual antiplatelet therapy discontinuation, as it has been shown to be associated with a lower risk for myocardial infarction and similar risk for major bleeding compared to aspirin monotherapy 5.