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.
Key red flags
New ischaemic chest pain, dynamic ECG change, troponin rise or abrupt symptoms after PCI require emergency ACS care.
Investigation priorities
Assess suspected ACS or stent thrombosis.
Management branches
Ischaemic chest pain or equivalent with possible ACS.
- Perform immediate ABC assessment, 12-lead ECG and activate the national ACS/reperfusion pathway when indicated.
- Give aspirin 300 mg orally as soon as possible unless genuinely contraindicated.
Stable after MI, PCI, ischaemic stroke/TIA or symptomatic peripheral arterial disease.
Key medicines
AspirinACS loading: 300 mg orally once; long-term secondary prevention: 75 mg orally once daily.
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.