Who needs dual antiplatelet therapy?

Dual antiplatelet therapy is recommended for an ABCD2 score of 4 or greater. Minor stroke can be identified by a National Institutes of Health (NIH) Stroke Scale score of 3 or less. The risk of recurrence after minor stroke is similar to that after a high-risk TIA.

When would you use dual platelet therapy?

Dual antiplatelet therapy should be started as soon as possible after brain imaging, within 24 hours of symptom onset, and ideally within 12 hours. Dual antiplatelet therapy should be started prior to discharge from the Emergency Department.

Who should be on DAPT?

DAPT for 12 months or more should be considered for patients at high risk of ischemic events (eg, due to prior myocardial infarction) and at low risk of bleeding.

What is the indication for dual antiplatelet therapy?

Indications that have been studied include coronary artery disease (CAD), atherosclerotic ischemic stroke, and atrial fibrillation. This combination has been beneficial in patients with acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI), and in PCI patients without an acute event.

Why is Dapt needed?

As with other blood-contacting medical devices, thrombosis is the predominant cause of failure after stent implantation. Accordingly, the goal of antithrombotic therapy in general and DAPT in particular is to reduce the risk of cardiovascular events, including stent thrombosis (ST),^4,5 a life-threatening emergency.

Dual anti-platelet therapy: How Long after PCI, CABG, ACS?

When do you give Dapt?

In summary, DAPT should be started as soon as possible within 24 hours of minor ischaemic stroke or high risk transient ischaemic attack and should be continued up to 21 days. The 21st day is the possible trade-off point to balance treatment effect and bleeding risk.

What is antiplatelet therapy used for?

Antiplatelet drugs are sometimes used to prevent blood clots, heart attacks and strokes, but are primarily used to prevent the recurrence of blood clots after a heart attack or stroke. They can also help relieve symptoms such as chest pain, poor circulation and shortness of breath.

When do you hold antiplatelet therapy?

If a patient's bleeding risk significantly outweighs the risk of stent thrombosis, or if active hemorrhage makes a patient hemodynamically unstable, antiplatelet therapy must be stopped.

Do you need DAPT after CABG?

In patients undergoing coronary artery bypass grafting (CABG), dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel is superior to aspirin alone for preventing saphenous vein graft failure, according to a meta-analysis in The BMJ.

Do you need Dapt for Nstemi?

Dual antiplatelet therapy (DAPT) in the treatment of NSTEMI occupies a vital position and has been proven to improve the prognosis of patients with NSTEMI [6–8]. DAPT specifically refers to the combination of antiplatelet therapy with aspirin and a P2Y₁₂ receptor inhibitor (clopidogrel, prasugrel, or ticagrelor).

Who gets Dapt stroke?

The American Heart Association secondary prevention guideline (2014) indicates that DAPT for 90 days in patients with severe intracranial stenosis is reasonable (Class IIb; Level of Evidence B), while patients with ischemic stroke/TIA due to atrial fibrillation who are unable to take oral anticoagulation can be treated ...

Do you need dual antiplatelet after CABG?

We found that post–coronary artery bypass grafting dual antiplatelet therapy with clopidogrel plus aspirin was associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months as compared with aspirin monotherapy, and there was no significant increase in major bleeding.

Is aspirin necessary after CABG?

Aspirin 81-325 mg/day is recommended for patients undergoing CABG, preoperatively and within 6 hours after surgery, to reduce graft occlusion and future cardiac events. Aspirin should be continued indefinitely unless contraindications arise.

How long does Dapt last after CABG?

In patients with ACS (NSTE-ACS or STEMI) being treated with DAPT who undergo coronary artery bypass grafting (CABG), P2Y₁₂ inhibitor therapy should be resumed after CABG to complete 12 months of DAPT therapy after ACS (Class I).

Is 1 year of dual antiplatelet therapy after stenting really necessary?

The duration of DAPT has not always to be recommended at the time of the stent implantation. The rule of 1 year DAPT treatment after stenting does no more apply to each patient. In patients treated with new-generation DES for stable coronary disease, 6 months (and perhaps 3) of DAPT is an option.

How long should patients be on dual antiplatelet therapy?

The most recent American College of Cardiology/American Heart Association guidelines on duration of dual‐antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug‐eluting stents (DESs) give a class I recommendation to continue DAPT for at least 12 months after an acute coronary syndrome (ACS) ...

What is the minimal duration of time that dual antiplatelet therapy should be continued?

Current evidence supports a DAPT duration for up to 33 months. However, we believe that if a patient has a high ischaemic risk, a patient should be treated with dual antiplatelet therapy for as long as the bleeding risk is acceptable; in some patients this could mean lifelong treatment.

What is the difference between blood thinner and antiplatelet?

Anticoagulants, more commonly referred to as “blood thinners,” work by inhibiting the clotting factors. Antiplatelets work by inhibiting the enzymes that cause the platelets to clump together.

Do antiplatelets lower BP?

Primary Results. The Antiplatelet Trialists' Collaboration meta-analysis of antiplatelet therapy for secondary prevention in patients with elevated blood pressure reported a 4.1 percent absolute reduction in vascular events compared with placebo.

When do you give antiplatelet to stroke?

Antiplatelet therapy should be started as soon as possible after brain imaging has excluded hemorrhage, within 24 hours of symptom onset (ideally within 12 hours) [Evidence Level B].

When do you start clopidogrel after a TIA?

Recent minor non-cardioembolic ischemic stroke or high-risk TIA, DAPT with aspirin plus clopidogrel should be initiated early (ideally within 12–24 hours of symptom onset and at least within 7 days of onset) and continued for 21–90 days.

How long is dual antiplatelet therapy after CABG?

The latest guidelines recommend the use of DAPT one year after CABG in patients with ACS (1, 9), although available evidence is limited to small RCTs and meta-analyses are substudies of larger RTCs.

How long keep Plavix after CABG?

So, for patients scheduled for CABG, the recommendation is to stop clopidogrel at least 5 days and, preferably, 10 days prior to surgery to minimize blood loss. In the case of aspirin, the recommendation is to maintain it up to surgery and beyond the time of surgery.

When can you stop Plavix after CABG?

The American College of Cardiology released an update to the guidelines on the use of dual antiplatelet therapy and assigned a Class IIB recommendation, indicating that it may be considered to use clopidogrel (initiating use early postoperatively) in addition to aspirin for up to 12 months.

Do you need anticoagulation after CABG?

There is weak evidence for post-CABG anticoagulation, with warfarin and rivaroxaban providing no protection against graft failure but decreasing long-term major adverse cardiac events. Anticoagulation seems to be indicated only in post-CABG patients at high risk of future ischemic events.