Antiplatelet and Anticoagulation Management for Coronary Angiography
Continue both aspirin and clopidogrel without interruption when coronary angiography is planned, as diagnostic angiography alone does not require discontinuation of dual antiplatelet therapy. 1, 2
Continuation of Current Medications
Aspirin 75-100 mg daily should be continued through the angiography procedure without interruption, as it is recommended lifelong in patients with prior MI or revascularization. 1
Clopidogrel 75 mg daily should be continued through diagnostic angiography without interruption, as there is no bleeding risk that outweighs the thrombotic protection during a diagnostic procedure. 1
No additional anticoagulation is required for diagnostic coronary angiography in patients already on dual antiplatelet therapy. 1
Management Based on Angiography Findings
If PCI/Stenting is Performed
Continue aspirin 75-100 mg daily throughout and after the procedure. 1
Continue clopidogrel 75 mg daily (ensure adequate loading dose of 600 mg was given if not already on maintenance therapy for >5 days). 1
Dual antiplatelet therapy should continue for 6 months as the default strategy after stenting in chronic coronary syndrome patients. 1
After 6 months of DAPT, transition to aspirin monotherapy 75-100 mg daily indefinitely. 1, 2
If CABG is Recommended
Continue aspirin 75-100 mg daily without interruption through surgery. 1
Discontinue clopidogrel 5-7 days before elective CABG to allow dissipation of antiplatelet effects and reduce bleeding risk. 1
For urgent CABG that cannot be delayed, surgery may proceed without stopping clopidogrel if the patient is at high risk for fatal ischemic events (e.g., refractory ischemia, severe left main disease), accepting increased bleeding risk. 3
Restart clopidogrel after CABG once hemostasis is secured (typically within 24-48 hours postoperatively) to complete 12 months of DAPT from the time of the acute event, as this patient has prior stenting. 2, 3
If Medical Management Only
Continue clopidogrel 75 mg daily to complete at least 12 months from the most recent stent placement, then transition to aspirin monotherapy. 1
Critical Pitfalls to Avoid
Never discontinue antiplatelet therapy for diagnostic angiography alone, as the bleeding risk is minimal and stent thrombosis risk is catastrophic. 4
Do not delay urgent CABG beyond 5-7 days solely to allow clopidogrel washout in patients with refractory ischemia or life-threatening anatomy, as the ischemic risk exceeds bleeding risk. 3
Do not forget to restart clopidogrel postoperatively in patients with recent stents or ACS, as failure to resume DAPT significantly increases risk of stent thrombosis and recurrent MI. 3, 5