For a patient with a coronary stent who needs daily low‑dose aspirin (81 mg), should I prescribe chewable aspirin or an enteric‑coated (time‑delayed) tablet?

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Last updated: February 18, 2026 • View editorial policy

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Aspirin Formulation for Patients with Coronary Stents

For a patient with a coronary stent requiring daily aspirin 81 mg, prescribe non-enteric-coated (chewable or regular) aspirin, not enteric-coated (time-delayed) formulations. 1

Why Non-Enteric-Coated Aspirin is Preferred

  • Enteric-coated aspirin should be avoided initially because of its delayed and reduced absorption, which is particularly problematic in patients requiring consistent antiplatelet effects for stent thrombosis prevention. 1

  • Non-enteric-coated formulations provide more rapid buccal absorption compared to enteric-coated preparations, ensuring more reliable and predictable antiplatelet activity. 1

  • The 2014 AHA/ACC guidelines explicitly recommend non-enteric-coated aspirin (162-325 mg loading dose) for acute coronary syndromes, with this principle extending to maintenance therapy where consistent absorption is critical. 1

Optimal Maintenance Dosing

  • The recommended maintenance dose is aspirin 81 mg daily, which should be continued indefinitely after stent placement. 1, 2

  • This 81 mg daily dose provides equivalent cardiovascular protection compared to higher doses (162-325 mg) while significantly reducing bleeding complications. 1, 3

  • High-dose aspirin (≥160 mg) is associated with increased bleeding risk without improved outcomes in patients on dual antiplatelet therapy. 1

Practical Implementation

  • Prescribe either chewable aspirin 81 mg or regular (non-enteric-coated) aspirin 81 mg tablets taken once daily. 1

  • Chewable formulations are particularly useful as they ensure buccal absorption and can be beneficial if rapid action is ever needed (though for maintenance therapy, either chewable or regular non-enteric-coated is acceptable). 1

  • Avoid prescribing "enteric-coated," "delayed-release," or "safety-coated" aspirin formulations for patients with coronary stents. 1

Duration and Monitoring

  • Aspirin therapy must be continued indefinitely in all patients with coronary stents, regardless of stent type (bare-metal or drug-eluting). 1, 2

  • If the patient is also on a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel), the aspirin dose should remain at 81 mg daily to minimize bleeding risk while maintaining dual antiplatelet efficacy. 1

Common Pitfalls to Avoid

  • Do not prescribe enteric-coated aspirin thinking it will reduce gastrointestinal side effects—the delayed absorption compromises antiplatelet effectiveness. 1

  • If gastrointestinal protection is needed, add a proton pump inhibitor rather than switching to enteric-coated aspirin. 2, 4

  • Do not use higher maintenance doses (325 mg) as they increase bleeding without additional cardiovascular benefit in the chronic setting. 1, 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Aspirin Therapy for Patients with History of Coronary Stent

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Aspirin Dosing Recommendations for Cardiovascular Conditions

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

4
Guideline

Aspirin Resumption After Lumbar Fusion in Ischemic Heart Disease

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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