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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Antiplatelet therapy in cardiovascular disease

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Escalate

Suspected stent thrombosis or ACS needs emergency assessment; major or intracranial bleeding on antiplatelets requires immediate resuscitation, haemostasis and senior cardiology/haematology input.

Synopsis

Select and monitor antiplatelet treatment for UK cardiovascular indications while recognising bleeding and thrombotic emergencies.

  • Antiplatelets prevent platelet-rich arterial thrombosis; they are not interchangeable with anticoagulants.
  • Give aspirin as soon as possible in suspected ACS unless there is a true contraindication.
  • Dual antiplatelet therapy means aspirin plus one P2Y12 inhibitor; indication and duration depend on ACS, PCI and bleeding risk.
  • After MI, low-dose aspirin is generally continued indefinitely; clopidogrel is an alternative when aspirin is contraindicated.
  • Do not routinely prescribe aspirin for primary prevention of CVD.
  • Prasugrel is contraindicated after previous stroke or TIA and is generally unsuitable from age 75 unless a specialist judges benefit to exceed risk.
  • Never stop DAPT soon after coronary stenting without urgent advice from the treating interventional cardiology team unless life-threatening bleeding makes immediate action unavoidable.

Key red flags

ACS or stent thrombosis

New ischaemic chest pain, dynamic ECG change, troponin rise or abrupt symptoms after PCI require emergency ACS care.

Major bleeding

Haemodynamic compromise, melaena, haematemesis, intracranial symptoms or a large haemoglobin fall are high-risk features.

Investigation priorities

01
12-lead ECG and serial troponinFirst step

Assess suspected ACS or stent thrombosis.

Management branches

FirstSuspected acute coronary syndrome

Ischaemic chest pain or equivalent with possible ACS.

  1. Perform immediate ABC assessment, 12-lead ECG and activate the national ACS/reperfusion pathway when indicated.
  2. Give aspirin 300 mg orally as soon as possible unless genuinely contraindicated.
  3. Select the P2Y12 inhibitor with the ACS and PCI strategy, age, stroke history, anticoagulation and bleeding risk in mind.
  4. Document the loading dose, maintenance regimen and planned duration before discharge.
NextLong-term secondary prevention

Stable after MI, PCI, ischaemic stroke/TIA or symptomatic peripheral arterial disease.

  1. Confirm the qualifying vascular diagnosis and whether DAPT remains required.
  2. Continue the nationally recommended single agent after the finite DAPT course; aspirin is generally indefinite after MI.
  3. Address smoking, lipids, blood pressure, diabetes and rehabilitation rather than treating antiplatelets as complete prevention.
  4. Review bleeding, adherence and the continuing indication at medication reviews.

Key medicines

AspirinACS loading: 300 mg orally once; long-term secondary prevention: 75 mg orally once daily.Active bleeding, true hypersensitivity and previous ulcer; assess GI protection. Enteric coating does not remove systemic bleeding risk.
Clopidogrel75 mg orally once daily. In non-ST-elevation ACS, use a 300 mg or 600 mg loading dose; a 600 mg load may be considered before PCI in adults under 75. STEMI and fibrinolysis regimens are timing- and age-specific.Bleeding; CYP2C19 interactions. Avoid routine co-prescribing with omeprazole or esomeprazole when another suitable PPI is available. In STEMI, patients older than 75 treated medically with fibrinolysis start 75 mg without a load; a 600 mg PCI load at age 75 or older needs individual bleeding-risk assessment.
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Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG185: Acute coronary syndromesNational ACS antiplatelet pathway.
  • NICE NG238: CVD risk assessment and reductionAspirin is not routinely offered for primary prevention.
  • NICE TA210: Clopidogrel and modified-release dipyridamoleSecondary prevention after occlusive vascular events.
  • Ticagrelor 90 mg SmPCUK loading, maintenance and aspirin doses.
  • Prasugrel 10 mg SmPCUK PCI dosing and contraindications.
  • Clopidogrel 75 mg SmPCSyndrome-, PCI-, fibrinolysis- and age-specific loading regimens.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom