The management of antiplatelet agents before a procedure is dependent on the assessment of the patient’s overall clinical status, thrombotic and bleeding risks, and the procedure-associated bleeding risk. For patients receiving DAPT scheduled to undergo a procedure associated with low bleeding risk, most antiplatelet agents can be continued. For patients receiving DAPT scheduled to undergo a procedure associated with high bleeding risk, the patient’s thrombotic risk, which is related to the duration of DAPT and to the original indication (eg, cardiac vs peripheral stent), must be taken into consideration. Consultation with the care team managing the antiplatelet therapy (eg, cardiovascular practitioner) is recommended for patients who have had a cardiac stent placed within the previous 12 months. For cardiac stent recipients who have completed 12 months of DAPT, the recommendation is to continue aspirin while withholding the second antiplatelet agent, and involvement of a multidisciplinary care team for management recommendations may be helpful. It should be noted that this figure is reflective of recommendations for patients receiving dual antiplatelet agents with the assumption that no other coagulation defect is present and that no other drug that may affect coagulation status has been administered. (*Patients who have a peripheral stent or bypass graft and who are receiving DAPT merit a separate discussion with their vascular provider.) ASA ¼ acetylsalicylic acid.

Reference:

• SIR Consensus Guidelines: Periprocedural Management of Thrombotic and Bleeding Risk - Part II. JVIR Volume 30, Issue 8, August 2019, Pages 1168-1184.e1