This patient, who has undergone drug-eluting stent placement following a non–ST-elevation myocardial infarction, should continue taking ticagrelor for 1 year. He also should continue taking aspirin indefinitely. The American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guidelines recommend at least 1 year of dual antiplatelet therapy for patients undergoing PCI with a drug-eluting stent (DES).

Antiplatelet drugs indicated for patients who have received a drug-eluting stent following an acute coronary syndrome are clopidogrel, ticagrelor, and prasugrel. In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was found to be superior to clopidogrel in reducing the incidence of cardiovascular death, myocardial infarction, and stroke following an acute coronary syndrome.

Dual antiplatelet therapy for patients who have undergone placement of a bare metal stent following an acute coronary syndrome is indicated for at least 4 weeks and up to 1 year. Following placement of a DES, however, a 30-day duration of ticagrelor is insufficient.

Despite numerous studies about the risk of very late stent thrombosis, defined as the occurrence of stent thrombosis greater than 1 year after placement, there is no recommendation for lifelong dual antiplatelet therapy in current treatment guidelines.

Stopping ticagrelor and starting clopidogrel is incorrect because there is no indication to stop ticagrelor, an agent that appears to be superior to clopidogrel in improving cardiovascular outcomes following an acute coronary syndrome. Cost and adverse events (including bleeding, dyspnea, and bradycardia) are the most common reasons for discontinuation of ticagrelor.