What is your preferred monotherapy antiplatelet agent to continue after completion of DAPT post-PCI for patients with stable ischemic heart disease?
For stable CAD that is more extensive, I have been using Plavix monotherapy based on data from HOST-Exam although I have a discussion with the patient. ASA monotherapy is certainly OK if the patient prefers it. However, the downside to clopidogrel monotherapy is when a patient needs a procedure late...
ASA or clopidogrel is a coin toss at this stage, with ASA ruffling fewer surgeon/dentist feathers than clopidogrel. Optimally, clopidogrel would offer similar anti-platelet activity to ASA, minus the GI cox-related bleeding risk.
As mentioned previously by multiple colleagues, the answer depends on the patient's CAD burden, history of ACS, risk factor control, etc.
- I would prefer clopidogrel monotherapy in patients with more than one vessel PCI, patients with a prior history of ACS, ongoing smoking, history of CVA (ischemic...
Clopidogrel is cheap and effective for most patients.
I still use aspirin although I'm staying tuned as data seems to suggest that clopidogrel or perhaps ticagrelor may be preferable.
Again, I do have some concerns about interrupting antiplatelet agents for procedures as there is generally more comfort doing procedures on ASA as opposed to clopidogrel ...
My personal approach is that we in interventional cardiology are stent-centric and forget that evidence shows repeat events are not a consequence of stent thrombosis (1-2%) but by in large a consequence of plague rupture and thrombosis. Therefore, if one decides to use DAPT (understanding the increa...