Patient Decision Aid

Medical procedure used in hospitals to unblock a blood vessel in the heart. Here are the steps:

• A small tube is inserted into the blocked vessel.
• Then, a balloon is inflated to reopen the passage and allow blood to flow again.

A small metal spring, called a stent, is usually placed in this area to keep the vessel open.

Medications, such as aspirin, given after a heart attack to reduce the risk of recurrence.

• They thin the blood and prevent clots from forming.

After a procedure in which a stent is placed, two medications of this type are often given at the same time. This is called dual antiplatelet therapy.

The duration of this dual antiplatelet therapy can vary. For example, the two drugs may be given together for 1 to 3 months or for longer, such as 12 months. After this period, one of the two drugs will be stopped.

There is a risk of recurrence or cardiac complication in people who have already had a heart attack. This can happen if a blood clot forms in a blood vessel in the heart or in the stent placed during the procedure. This type of complication can lead to another heart attack and sometimes lead to death.

The risk of recurrence or cardiac complications varies from person to person. Antiplatelet drugs can reduce this risk. When the procedure is complex, for example when several vessels need to be unblocked or several stents need to be inserted, the risk of recurrence or complications is higher.

Out of 100 adults treated with a complex procedure, about 5 of them (5%) will have a heart attack or die from a heart problem in the next year.

For people who have undergone a complex procedure, a longer duration of dual antiplatelet therapy may be preferred to reduce this risk.

The risk of bleeding varies from person to person. Certain individual characteristics and medical conditions can increase the risk of bleeding.

Antiplatelet drugs thin the blood, which increases the risk of bleeding in patients who take them. Antiplatelet drugs can cause minor bleeding, such as nosebleeds or skin bruising (bruises on the body). But antiplatelet drugs can also cause major bleeding, such as bleeding in the brain or stomach. Major bleeding requires hospitalization and urgent treatment such as transfusions, as it can sometimes lead to death.

Out of 100 adults considered to be at high risk of bleeding and treated with standard dual antiplatelet therapy, it is estimated that at least 4 of them (4%) will experience major bleeding in the next year.

In people at high risk of bleeding, a shorter duration of dual antiplatelet therapy may be preferable to reduce this risk.

There is concern that a shorter duration (1 to 3 months) of dual antiplatelet therapy may lead to more recurrences or cardiac complications in patients who have undergone complex percutaneous coronary intervention.

However, longer treatment (12 months) increases the risk of major bleeding, particularly in patients who are already at high risk of bleeding.

Current scientific data does not clearly indicate whether either strategy is preferable in patients who are both at high risk of bleeding and have undergone a complex procedure. The decision should therefore be guided by an individualized assessment of the patient's risks and priorities.