Top Things to Know: Top Things to Know
Updated: October 13, 2026
Prepared by Kevin J. Mercer, PharmD, MPH, FCCM, Science & Medicine Advisor, American Heart Association
- Antiplatelet therapy is foundational for acute coronary syndromes (ACS) and chronic coronary disease (CCD), but medication selection, dose, and duration should be individualized by thrombotic and bleeding risk.
- Guideline-based therapy remains the foundation of antiplatelet management, with dual antiplatelet therapy (DAPT) duration and P2Y12 inhibitor selection tailored to the clinical scenario.
- Shorter DAPT strategies may reduce bleeding in selected patients, but limitations of existing evidence warrant caution when applying these approaches to patients at high thrombotic risk.
- Multidisciplinary care brings complementary expertise to complex antiplatelet decisions across the care continuum and carries a Class 1, Level of Evidence A recommendation in current CCD guidance.
- Pharmacists are key antithrombotic stewardship partners, supporting medication optimization, reconciliation, interaction assessment, patient education, adherence, access, care coordination, and quality improvement.
- Medication adherence, affordability, and transitions of care can substantially affect antiplatelet therapy, making proactive medication reconciliation, access assessment, education, and structured handoffs essential.
- Escalation, de-escalation, or switching of antiplatelet therapy should reflect evolving clinical risk and patient-specific factors, while pharmacogenomic and platelet-function testing should remain selective rather than routine.
- Perioperative antiplatelet management requires coordinated multidisciplinary planning to balance thrombotic and bleeding risks surrounding therapy interruption, continuation, bridging, and reinitiation.
- Antithrombotic stewardship can improve the safety and consistency of antiplatelet care through standardized pathways, clinical decision support, active medication review, and longitudinal monitoring.
- Future research should refine precision antiplatelet therapy, multidisciplinary stewardship, management of high-risk patients, and emerging approaches to individualized thrombotic and bleeding risk prediction.
Citation
Beavers CJ, Dobesh PP, Cushman M, DiDomenico RJ, Ijioma N, Joshi RV, Medina-Beckwith J, Pereira N, Ruel M, Tabak RG; on behalf of the Ameri¬can Heart Association Clinical Pharmacology Committee of the Council of Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Genomic and Precision Medicine. Multidisciplinary approach to antiplatelet management in coronary syn¬dromes: a scientific statement from the American Heart Association. Published online October 13, 2026. Circulation. doi: 10.1161/CIR.0000000000001478