Single Antiplatelet Therapy After DAPT for Single Vessel PCI
Yes, single antiplatelet therapy (SAPT) should be continued lifelong after completing DAPT for one year in patients with ischemic heart disease who underwent PCI for single vessel disease. 1
Standard Approach After DAPT Completion
After completing the recommended DAPT duration following PCI, lifelong antiplatelet monotherapy is the standard of care for secondary prevention in chronic coronary syndrome patients 1:
- Aspirin 75-100 mg daily is recommended lifelong after the initial DAPT period in patients with prior MI or remote PCI (Class I, Level A recommendation) 1
- Clopidogrel 75 mg daily is a safe and effective alternative to aspirin monotherapy and can be used lifelong instead of aspirin (Class I, Level A recommendation) 1
DAPT Duration for Your Patient Population
For stable ischemic heart disease (SIHD) patients undergoing PCI with drug-eluting stents 1:
- Minimum 6 months of DAPT with aspirin and clopidogrel is required (Class I recommendation) 1
- After 6-12 months, transition to single antiplatelet therapy is appropriate for most patients 1
- The aspirin dose during DAPT and after should be 81 mg daily (range 75-100 mg) 1
Extended DAPT Considerations
Extension beyond 12 months may be reasonable in select circumstances 1:
- Patients who tolerated DAPT without bleeding complications 1
- Those NOT at high bleeding risk (no prior bleeding on DAPT, no coagulopathy, no oral anticoagulant use) 1
- Patients at enhanced ischemic risk (Class IIa recommendation) 1
However, DAPT is NOT beneficial in SIHD patients without prior ACS, stent implantation, or recent CABG (Class III recommendation) 1
Choice of Long-term SAPT Agent
Both options are equally endorsed by the 2024 ESC guidelines 1:
- Aspirin 75-100 mg daily - traditional first choice
- Clopidogrel 75 mg daily - equivalent alternative with potentially lower GI bleeding risk
The choice between aspirin and clopidogrel for lifelong therapy can be based on individual tolerability, side effect profile, and patient preference 1.
Critical Pitfalls to Avoid
Do not discontinue all antiplatelet therapy after completing DAPT - this is a common and dangerous error 1. The transition is from dual to single antiplatelet therapy, not from dual to none.
Do not continue DAPT indefinitely without reassessment - prolonged DAPT beyond 12 months increases bleeding risk without clear benefit in stable, low-risk patients 1, 2. Research shows that while extended DAPT may reduce ischemic events in high-risk patients, it comes with increased bleeding complications 2, 3.
Avoid premature DAPT discontinuation within the first 6-12 months without compelling reasons (such as life-threatening bleeding or urgent surgery requiring anticoagulation) 4.