GPAtlas🧭 When this applies (the GP's role in antiplatelet review)
This topic covers the ongoing primary-care management of patients already taking antiplatelet therapy for secondary prevention – after a myocardial infarction or acute coronary syndrome (ACS), an ischaemic stroke or TIA, or for peripheral arterial disease (PAD). The task is not diagnosis but safe, effective continuation.
Four questions drive every review: is the indication correct and still valid; is the ischaemic benefit still outweighing the bleeding risk; is the patient adherent; and does this patient need gastroprotection? The two clinical skills are to match the agent to the indication and to recognise major bleeding early.
| Indication | Usual first-line agent | Key point |
|---|---|---|
| Post-MI / ACS | Aspirin 75 mg daily, long-term | A second antiplatelet is added for up to 12 months, then stopped – aspirin continues indefinitely |
| Ischaemic stroke / TIA | Clopidogrel 75 mg daily, long-term | Short-term aspirin + clopidogrel for 21 days may precede this after high-risk TIA / minor stroke (specialist-initiated) |
| Peripheral arterial disease | Clopidogrel 75 mg daily | Rivaroxaban 2.5 mg twice daily plus aspirin is a specialist option where ischaemic risk is high |
| Aspirin intolerance / hypersensitivity | Clopidogrel 75 mg daily | Clopidogrel monotherapy is the standard alternative to aspirin in any indication |
Scrutinise bleeding risk most closely in the over-65s, those on multiple bleeding-risk drugs (NSAIDs, anticoagulants, SSRIs, corticosteroids), and anyone with previous peptic ulcer or GI bleeding.
Source: NICE NG185 · NICE NG128 · NICE CG147
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