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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)”

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