Hemostasis Today
NewsFeed
Headlines Hematology Health Medicine VTE ASH Plasma Donation
July, 2026
July 2026
M T W T F S S
 12345
6789101112
13141516171819
20212223242526
2728293031  
Edward Lee Carter: What Is Changing in Antiplatelet Deprescribing and Why It Matters
Edward Lee Carter/LinkedIn
May 22, 2026, 16:25

Edward Lee Carter: What Is Changing in Antiplatelet Deprescribing and Why It Matters

Edward Lee Carter, Clinical Pharmacist Practitioner at U.S. Department of Veterans Affairs, shared a post on LinkedIn:

“Antiplatelet Deprescribing: What’s Changing Why It Matters

Based on 2026 Anticoagulation Forum Clinical Guidance

The Big Shift:

Evidence increasingly shows that adding antiplatelets to anticoagulation substantially increases bleeding risk with uncertain antithrombotic benefit. Many patients on dual therapy don’t need to be. Time to rethink long-standing habits!

Do:

  • Periodically review indication, bleeding risk, timing, dose of antiplatelet therapy
  • Evaluate the need to restart APT only when clinically indicated in the absence of OAC
  • Continue APT for patients with ASCVD on rivaroxaban 2.5 mg BID (stable CAD, stable and post-intervention PAD)
  • Add PPI for gastroprotection if a patient must remain on concomitant therapy
  • Evaluate indication for anticoagulation, particularly in VTE

Don’t:

  • Routinely use APT for primary prevention
  • Routinely add APT to OAC in stable ASCVD
  • Routinely use APT with mechanical prosthetic heart valves
  • Add APT for acute ischemic stroke in the setting of AF
  • Wait until a patient bleeds before stopping inappropriate APT — be proactive!

Consider:

  • Evaluating the need to add APT during periprocedural periods if anticoagulation is held
  • Shared decision-making with patients using visual decision-aids for bleeding vs. thrombotic risk

Antiplatelet Deprescribing — Quick-Hit Scenario Guide

  • Stable CAD with OAC (PCI, MI, or CABG more than 6–12 months prior): stop antiplatelet therapy.
  • Stable PAD with OAC and no other indication for antiplatelet therapy: stop antiplatelet therapy.
  • Prior TIA or stroke with newly diagnosed AF or VTE: stop antiplatelet therapy.
  • Following PCI within the past 6–12 months: continue antithrombotic therapy, preferably with OAC plus a P2Y12 inhibitor; stop aspirin after 1–4 weeks.
  • Patients with HeartMate III or BiVAD support: stop antiplatelet therapy.
  • Patients with HeartMate II, HVAD, or total artificial heart support: continue antiplatelet therapy.
  • LAAO patients receiving OAC for a non-AF indication: stop antiplatelet therapy.
  • Mechanical heart valve patients treated with warfarin: stop antiplatelet therapy, except in selected On-X valve cases.
  • APS patients with arterial thrombosis and additional cardiovascular risk factors: continue antiplatelet therapy.

Stewardship Action Items:

  • Clarify ownership of APT decisions across inpatient, outpatient, procedural settings
  • Implement EHR-based triggers to flag patients on combined antithrombotic therapy
  • Standardize expectations for antiplatelet duration reassessment
  • Develop patient-facing education tools to support deprescribing conversations

Bottom line:

If your patient is on therapeutic anticoagulation, ask yourself — do they really still need that antiplatelet? More often than not, the answer is no.

Source: Anticoagulation Forum – Antithrombotic Clinical Guidance (April 2026)”

Stay updated with Hemostasis Today.

acute ischemic stroke AF Anticoagulation Forum Antiplatelet Deprescribing Antiplatelet Therapy Antiplatelets ASCVD Aspirin BID BiVAD Blood DOACs Edward Lee Carter Health HeartMate II HeartMate III Hematology Hemostasis Hemostasis News Hemostasis Today HVAD LAAO Medicine OAC PAD PPI Rivaroxaban stable CAD thrombosis VTE Warfarin
NewsFeed