What is the aftercare for Percutaneous Coronary Intervention (PCI)?

From the Guidelines

After a Percutaneous Coronary Intervention (PCI), patients should follow a structured aftercare plan, with dual antiplatelet therapy (DAPT) consisting of aspirin 75–100 mg and clopidogrel 75 mg daily for up to 6 months as the default antithrombotic strategy, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1. The cornerstone of PCI aftercare is DAPT, which helps prevent local thrombotic complications related to stent implantation and reduces systemic atherothrombotic events.

• Key considerations for DAPT duration include:
  • Patients with no indication for oral anticoagulation: DAPT for up to 6 months is recommended 1.
  • Patients at high bleeding risk but not at high ischemic risk: DAPT can be discontinued 1–3 months after PCI, and single antiplatelet therapy can be continued 1.
  • Patients not at high bleeding risk nor at high risk of ischemic events: Stopping DAPT after 1–3 months from PCI-stenting may be considered 1.
• Other essential aspects of PCI aftercare include:
  • Wound care: keeping the insertion site clean and dry, watching for signs of infection or bleeding.
  • Follow-up appointments: scheduled within 2-4 weeks after the procedure, with regular cardiac check-ups thereafter.
  • Lifestyle modifications: smoking cessation, adopting a heart-healthy diet, engaging in regular moderate exercise (after clearance from their doctor), and managing stress. These measures are essential for preventing stent thrombosis, reducing the risk of future cardiac events, and promoting overall cardiovascular health, as supported by the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease 1 and the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention 1.

From the Research

Aftercare for Percutaneous Coronary Intervention (PCI)

The aftercare for PCI involves the use of antiplatelet therapy to prevent major adverse cardiac events.

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard of care after PCI with drug-eluting stents (DES) 2, 3, 4.
• The optimal duration of DAPT depends on the individual's bleeding risk profile, initial clinical presentation, and complexity of coronary stenting 2, 3.
• DAPT is recommended for at least 6 and 12 months following PCI with DES among patients with stable ischemic heart disease and acute coronary syndrome, respectively 3.
• For patients with an indication for long-term oral anticoagulation (OAC), the optimal antithrombotic therapy after PCI is uncertain, but recent data suggest that the duration of DAPT can be limited to 1-3 months following new-generation drug-eluting stent deployment 5.
• Aspirin should be continued indefinitely, and a low dose (75-100 mg daily) is preferred over higher doses 4.
• A P2Y12 inhibitor should be administered for 12 months after PCI, unless the patient is at high risk for bleeding 4.
• After completing DAPT, clopidogrel may be associated with reductions in major adverse cardiac events (MACE) and stroke compared to aspirin monotherapy 6.

Special Considerations

• Patients who require warfarin are at high risk for bleeding if they also receive DAPT, and omission of aspirin may be advantageous in such patients 5, 4.
• Noncardiac surgery should be delayed until 12 months after coronary stenting, if possible 4.
• Routine platelet function or genetic testing is currently not recommended to tailor antiplatelet therapy after PCI 4.