Antiplatelet Therapy in the Management of Atherosclerotic Cardiovascular Disease: 2026 ACC Scientific Statement: A Report of the American College of Cardiology.

Abstract (English)

Antiplatelet medications have been fundamental to the management of atherosclerotic cardiovascular disease (ASCVD); however, recommendations for their use have evolved over the past decade. Aspirin remains the most widely used antiplatelet drug. Recent data do not support a benefit for primary prevention of ASCVD in unselected populations with routine aspirin use; consideration should be reserved for those at highest ischemic risk. Similarly, the evolution of drug-eluting stents, antiplatelet medications, and research on the optimal regimen and duration of dual antiplatelet therapy have altered evidence-based recommendations for use of antiplatelets in managing patients diagnosed with ASCVD. Antiplatelet medications remain powerful tools to prevent ischemic events, particularly for those who have experienced an acute coronary syndrome, but the balance between the risk of ischemia and the risk of bleeding poses a perpetual challenge and requires individualized treatment. This scientific statement provides a detailed overview of current evidence for the use of antiplatelets in the management of ASCVD. This includes a comparison of current clinical practice guideline-based recommendations, summary of pivotal trials, and discussion of antiplatelet use in patients with elevated bleeding risk or those undergoing surgery. Considerations for use of antiplatelets in those with different phenotypes of ASCVD and those with indications for concurrent use of antithrombotic medications, as well as long-term monitoring and adherence, are addressed.