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)
• after an ischaemic stroke or TIA
• for peripheral arterial disease (PAD).
The aim is safe, effective continuation, not diagnosis.
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?
• Does this patient need gastroprotection?
Match the agent to the indication and 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 or TIA | Clopidogrel 75 mg daily, long-term | Short-term aspirin + clopidogrel for 21 days may precede this after high-risk TIA or 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 or 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 gastrointestinal (GI) bleeding.
Source: NICE NG185 · NICE NG128 · NICE CG147
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