What is the typical antiplatelet strategy after peripheral vascular stenting?

• A. Anticoagulation with warfarin long-term.
• B. No antiplatelet therapy.
• C. Dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) for a defined period, followed by single antiplatelet therapy long-term; specifics vary by lesion and protocol.
• D. Aspirin alone for life.

Answer: (C)

After peripheral vascular stenting, the main goal of antiplatelet therapy is to prevent stent thrombosis during the healing period when the vessel is most vulnerable. Starting with dual antiplatelet therapy—aspirin plus a P2Y12 inhibitor—provides two complementary ways to suppress platelet activation: aspirin blocks thromboxane A2 production, while the P2Y12 inhibitor prevents ADP-mediated platelet aggregation. This combination reduces the risk of early thrombosis while the stent becomes covered by neointimal tissue.

Once the stent is endothelialized and the risk of acute thrombosis diminishes, therapy is typically de-escalated to a single antiplatelet agent for long-term protection, with aspirin alone being the common long-term choice. The exact durations depend on the type of stent used (bare-metal vs. drug-eluting), the lesion location, and the specific protocol being followed.

Long-term anticoagulation with warfarin is not the standard approach after peripheral stenting unless there’s another indication for full anticoagulation. Not using antiplatelet therapy would leave the stent highly susceptible to thrombosis, and aspirin alone for life may be insufficient in the early period after stenting.