What should be considered when discontinuing dual antiplatelet therapy in a patient with previously controlled diabetes and an NSTEMI?

When discontinuing dual antiplatelet therapy in a patient who has had a non-ST elevated myocardial infarction (NSTEMI), it is essential to evaluate the balance between bleeding risk and the potential cardiovascular benefit of continuing the therapy. Dual antiplatelet therapy, usually comprising aspirin and a P2Y12 inhibitor, is often necessary in the initial management of NSTEMI to prevent thrombotic events.

However, prolonged dual antiplatelet therapy can increase the risk of bleeding complications, which is particularly important to consider in patients with additional risk factors, such as advanced age or concurrent use of anticoagulants. Assessing the patient’s individual bleeding risk — through tools like the HAS-BLED score or simply by evaluating clinical characteristics — allows healthcare providers to make informed decisions about whether to continue or discontinue the therapy.

On the other hand, the cardiovascular benefits of maintaining this treatment must also be weighed carefully. In patients who have had an NSTEMI, the protection against recurrent ischemic events is a critical consideration, especially in those with diabetes, whom studies have shown to be at higher risk for future cardiovascular events.

This comprehensive assessment ensures that patient management remains optimal and individualized, considering both safety and therapeutic efficacy.