Management of DAPT in a Patient With SIHD

A 54-year-old male active smoker with diabetes, hypertension, and history of coronary artery disease was referred to you for routine evaluation and to establish care after relocating. He reports he has been feeling well and has been active with no exertional limitations. His medical records demonstrate history of a percutaneous coronary intervention (PCI) 6 months ago after having an abnormal stress test following referral for evaluation of recurrent angina. Your patient states he has been chest-pain free since revascularization. The angiogram is not available to you for review, but the medical records include a copy of the procedure report. Review of the cardiac catheterization report shows rotational atherectomy was performed followed by implantation of a 3.0 x 38 mm drug-eluting stent (DES) in the proximal left anterior descending (LAD) artery. In addition to guideline-directed medical therapy, he has been taking dual antiplatelet therapy (DAPT) since his procedure with no issues. Your patient reports that his DAPT regimen includes aspirin 81 mg once daily and ticagrelor 90 mg twice daily.

After discussing with your patient the risks and benefits of DAPT including bleeding and ischemic risk, which of the following would you recommend as the best course of action for his antiplatelet regimen at this time?

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