Periprocedural thrombotic risk for patients on antiplatelet therapy

Risk stratum	Indication for antiplatelet therapy
Risk stratum	Coronary artery disease*	Cerebrovascular disease	Peripheral arterial disease
High thrombotic risk	Acute coronary syndrome ≤6 months Cardiac stent ≤6 months	Stroke or TIA ≤3 months
Low thrombotic risk	Ischemic heart disease without stent Cardiac stent >6 months Acute coronary syndrome >6 months	Stroke or TIA >3 months	PAD without revascularization PAD with revascularization^¶

Risk stratification is based upon the available data and consensus opinion. Consultation with the clinician who is managing the patient's long-term antiplatelet therapy is required for risk assessment and prior to interrupting antiplatelet therapy. This approach is intended as clinical guidance and does not substitute for clinical judgment in decisions about periprocedural management of antiplatelet agents.

TIA: transient ischemic attack; PAD: peripheral arterial disease.
* Some patients remain on dual antiplatelet therapy (eg, clopidogrel and aspirin) beyond the minimum duration (ie, 6 to 12 months) because of an underlying condition that confers additional risk (eg, reduced left ventricular ejection fraction, history of diabetes, prior history of stent thrombosis, less than optimal stenting result). Refer to UpToDate topics on the management of coronary artery disease.
¶ For most patients with PAD following revascularization, the risk of thrombosis with cessation of antiplatelet agents including aspirin can be variable and depends on the type and location of revascularization. Refer to UpToDate topics for content on the management of peripheral arterial disease.

Graphic 121390 Version 1.0

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Periprocedural thrombotic risk for patients on antiplatelet therapy