Patients with diabetes have increased long-term risk for recurrent atherothrombotic events. As such, intensive long-term antithrombotic therapy should be carefully considered in this setting. According to guidelines from the ACC/AHA and the European Society of Cardiology, dual antiplatelet therapy (DAPT) consisting of aspirin therapy plus a P2Y12 inhibitor is recommended for patients after myocardial infarction. DAPT should be continued for at least 1 year.
ACC/AHA guidelines specifically recommend:
In patients with acute coronary syndrome (non-ST elevation-acute coronary syndrome [NSTE]-ACS or ST-segment elevation myocardial infarction [STEMI]) treated with DAPT after coronary stent implantation, it is reasonable to use ticagrelor in preference to clopidogrel for maintenance P2Y12 inhibitor therapy.
In patients with acute coronary syndrome (NSTE-ACS or STEMI) treated with DAPT after coronary stent implantation who are not at high risk for bleeding complications and who do not have a history of stroke or transient ischemic attack, it is reasonable to choose prasugrel over clopidogrel for maintenance P2Y12 inhibitor therapy.
In patients with acute coronary syndrome (NSTE-ACS or STEMI) treated with coronary stent implantation who have tolerated DAPT without a bleeding complication and who are not at high bleeding risk (eg, prior bleeding on DAPT, coagulopathy, oral anticoagulant use), continuation of DAPT (clopidogrel, prasugrel, or ticagrelor) for longer than 12 months may be reasonable.
In patients with acute coronary syndrome treated with DAPT after drug-eluting stent implantation who develop high risk for bleeding (eg, treatment with oral anticoagulant therapy), are at high risk for severe bleeding complications (eg, major intracranial surgery), or develop significant overt bleeding, discontinuation of P2Y12 inhibitor therapy after 6 months may be reasonable.
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Cite this: Alanna Morris. Skill Checkup: Man With a History of Type 2 Diabetes Complicated by Peripheral Neuropathy Presents With New Dyspnea - Medscape - Jan 27, 2022.