Dual Antiplatelet Therapy After Stent Placement: How Long Is Long Enough?
The Clinical Dilemma: When to Stop DAPT?
A 74-year-old woman, six months out from a drug-eluting stent, wants to simplify her medication regimen. She’s on aspirin and clopidogrel, but recurrent nosebleeds raise the question: is it time to stop clopidogrel, or should dual therapy continue?
This type of nuanced clinical decision is exactly what long-time MKSAP learners remember from Dr. Don Dye’s teaching style: practical, case-based, and laser-focused on the “so what?” for everyday practice.
Current DAPT Guidelines: What the Experts Recommend
The ACC/AHA/SCAI guidelines offer a clear framework:
- Stable Ischemic Heart Disease
- At least 6 months of DAPT (aspirin + clopidogrel).
- Then, aspirin alone for most patients.
- High thrombosis risk (e.g., diabetes, LV dysfunction, complex stenting): consider extending DAPT if bleeding risk is low.
- High bleeding risk (e.g., prior GI bleed, recurrent epistaxis): shorten DAPT to 3–6 months, then continue aspirin only.
The Clinical Art: Balancing Bleeding and Thrombosis Risk
Dr. Dye was known for reminding learners that:
“The evidence gives you boundaries. The art of internal medicine is knowing where your patient lives inside those boundaries.”
That perspective resonates today. Managing dual antiplatelet therapy isn’t about memorizing durations — it’s about tailoring the decision to the individual sitting in front of you.
Key Takeaways for Practice
- Six months is enough for most patients after a stent in stable ischemic heart disease.
- Individualize therapy — extend DAPT for high thrombosis/low bleed risk; shorten for high bleed risk.
- Aspirin is lifelong therapy unless contraindicated.
- Shared decision-making is not optional — it’s central to good care.
Learn More with MKSAP Audio: Real Cases, Real Decisions
MKSAP has always been about more than right answers. It’s about learning medicine the way physicians like Dr. Don Dye taught it — with clarity, compassion, and clinical realism.
Today, that tradition continues in MKSAP Audio, where hosts Dr. Prentiss Taylor and Dr. Sarah Vick unpack cases just like this stent dilemma. They break down not only what the guidelines say, but how to apply them in the clinic tomorrow.
Why Clinicians Trust MKSAP
- 1,200+ real-world, board-style questions with critiques that feel like sitting beside a mentor.
- Concise updates on guidelines — distilled so you don’t have to.
- A trusted companion for CME, exam prep, and day-to-day patient care.
It’s no wonder so many learners say MKSAP still carries “the voice of Dr. Dye” — even as it evolves with new contributors, new technology, and fresh cases.
Ready to sharpen your instincts and pass with confidence?
MKSAP Audio brings clinical nuance to life—like when to stop dual antiplatelet therapy—through real-world cases and trusted voices. Visit the MKSAP Audio Companion page to explore all 16 topic areas, listen to free audio samples, and see why thousands trust our Pass Guarantee. Click here to get started.