What is the recommended duration of Aspirin (Acetylsalicylic Acid) therapy after stent placement?

Duration of Aspirin Therapy After Coronary Stent Placement

After coronary stent placement, aspirin therapy should be continued indefinitely regardless of stent type (bare-metal or drug-eluting). 1

Recommended Aspirin Regimen

Initial Dosing

• Initial aspirin dose: 81-325 mg non-enteric coated aspirin before PCI 1
• For patients already on aspirin: Continue with 81-325 mg before procedure 1

Maintenance Dosing

• After PCI, a maintenance dose of 81 mg daily is preferred over higher doses 1
• Lower dose (81 mg) is associated with reduced bleeding risk while maintaining efficacy 1, 2

Duration of Therapy Based on Stent Type and Clinical Scenario

All Stent Types

• Aspirin: Continue indefinitely (lifelong therapy) 1, 3

Dual Antiplatelet Therapy (DAPT) Recommendations

• ACS patients with any stent type: P2Y12 inhibitor plus aspirin for at least 12 months 1, 3
• Non-ACS patients with DES: P2Y12 inhibitor plus aspirin for at least 12 months if not at high bleeding risk 1
• Non-ACS patients with BMS: P2Y12 inhibitor plus aspirin for minimum 1 month, ideally up to 12 months 1

Special Considerations

Extended DAPT Duration

• Continuation of DAPT beyond 12 months may be considered in patients with DES 1, 3
• This decision should balance thrombotic risk versus bleeding risk 1, 3

Early Discontinuation of P2Y12 Inhibitor

• If bleeding risk outweighs benefit, earlier discontinuation of P2Y12 inhibitor (<12 months) is reasonable 1
• However, aspirin should still be continued indefinitely 1

Historical Context

• Previously, higher initial maintenance doses of aspirin (325 mg daily) were recommended for 1 month after BMS and 3-6 months after DES 1
• Current evidence supports lower maintenance doses (81 mg daily) for all patients 1, 2

Important Clinical Considerations

• Patients should be explicitly instructed not to stop aspirin therapy without consulting their cardiologist 3
• Premature discontinuation of antiplatelet therapy significantly increases the risk of stent thrombosis 4
• For patients requiring triple therapy (aspirin, P2Y12 inhibitor, and anticoagulant), a lower aspirin dose (81 mg) is preferred to reduce bleeding risk 3
• Aspirin resistance occurs in some patients (10-20%), which may require monitoring in high-risk patients 5

Algorithm for Aspirin Management After Stenting

1. Start with aspirin 81-325 mg before PCI
2. Continue aspirin indefinitely at 81 mg daily maintenance dose
3. Combine with appropriate P2Y12 inhibitor based on stent type and clinical scenario
4. Never discontinue aspirin without cardiologist approval
5. Consider bleeding risk when determining optimal DAPT duration, but maintain aspirin therapy regardless