Antiplatelets: Summary of Latest Guidance

Key points

• NSTEMI/ACS: aspirin (lifelong) plus a second antiplatelet — ticagrelor, or prasugrel if PCI — for 12 months; if aspirin is contraindicated, clopidogrel lifelong.
• STEMI having primary PCI: aspirin (lifelong) plus prasugrel (ticagrelor or clopidogrel as alternatives) — dual antiplatelet therapy for 12 months (bare-metal stents are now rarely used).
• TIA & ischaemic stroke: clopidogrel is first-line for long-term secondary prevention (aspirin an alternative). Within 24 h of minor ischaemic stroke or high-risk TIA, give short-term DAPT — clopidogrel + aspirin for 21 days (or ticagrelor + aspirin for 30 days) — then clopidogrel monotherapy. Aspirin + MR dipyridamole is now only a fallback.
• Peripheral arterial disease: clopidogrel first-line; aspirin second-line.
• The old anomaly (stroke got clopidogrel, TIA got aspirin + dipyridamole) has been resolved — clopidogrel is now first-line for both.