From the Guidelines
Patients who have undergone a RACE procedure should continue Plavix (clopidogrel) for at least 12 months following the procedure, as recommended by the most recent guidelines 1. The standard dosage is typically 75 mg once daily. It's essential to note that the choice of antiplatelet therapy may depend on the patient's specific clinical situation, including their risk of bleeding and ischemic events.
- The 2018 ESC guidelines recommend continuing P2Y12 inhibitor therapy, such as ticagrelor or clopidogrel, for 12 months in patients with acute coronary syndrome (ACS) who are managed with medical therapy alone 1.
- Ticagrelor is recommended over clopidogrel, unless the bleeding risk outweighs the potential ischemic benefit 1.
- In patients with medically managed ACS who are at high risk of bleeding, DAPT for at least 1 month should be considered 1.
- The 2016 ACC/AHA guidelines also recommend P2Y12 inhibitor therapy for at least 12 months in patients with ACS treated with DAPT after coronary stent implantation 1.
- However, the most recent and highest quality study, the 2018 ESC guidelines, takes precedence in guiding clinical decision-making 1. Key considerations for patients on Plavix include:
- Taking the medication with food or without food at the same time each day to maintain consistent blood levels
- Being vigilant for signs of bleeding, such as unusual bruising, nosebleeds, or blood in urine or stool, and reporting these to their doctor immediately
- Regular follow-up appointments to monitor their response to the medication and determine when it's appropriate to discontinue therapy.
From the Research
Guidelines for Plavix after PCI
- The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents remains uncertain 2.
- Extended-term DAPT is associated with a reduced risk of myocardial infarction, but also with a higher risk of major bleeding compared to shorter durations of DAPT 2.
- P2Y12 inhibitor monotherapy after DAPT discontinuation is associated with a lower risk of myocardial infarction and similar risk of major bleeding compared to aspirin monotherapy 3, 4, 5.
Comparison of Aspirin and P2Y12 Inhibitor Monotherapy
- Aspirin monotherapy is associated with a higher risk of myocardial infarction compared to P2Y12 inhibitor monotherapy 4, 5.
- P2Y12 inhibitor monotherapy is associated with a lower risk of stroke (ischemic and hemorrhagic) compared to aspirin monotherapy 4.
- There are no significant differences in mortality, major bleeding, and repeat revascularization between aspirin and P2Y12 inhibitor monotherapy 4.
Duration of DAPT
- Dual antiplatelet therapy for six months after PCI remains the standard recommendation for patients with stable ischemic heart disease 3.
- The duration of DAPT may be shortened and followed by P2Y12 inhibitor monotherapy or prolonged based on individualized evaluation of the patient's risk profile 3.
- Extended-term DAPT is associated with a reduced risk of myocardial infarction, but also with a higher risk of major bleeding compared to shorter durations of DAPT 2.