This American College of Cardiology scientific statement provides a comprehensive review of contemporary evidence for antiplatelet therapy in the management of atherosclerotic cardiovascular disease (ASCVD). The document synthesizes recent trial data, compares current guideline-based recommendations, and addresses practical clinical questions about antiplatelet selection, regimen duration, and monitoring. It aims to inform individualized treatment decisions by highlighting both ischemic benefits and bleeding risks across different patient phenotypes and clinical contexts.
Aspirin remains the most widely used antiplatelet agent worldwide. However, the statement highlights that recent evidence does not support routine aspirin use for primary prevention of ASCVD in unselected populations. Instead, consideration of aspirin for primary prevention should be limited to individuals at the highest ischemic risk, where potential benefits may outweigh bleeding hazards. The report emphasizes individualized risk assessment when considering aspirin for primary prevention.
Technological advances in coronary stents, notably developments in drug-eluting stents, together with new antiplatelet agents and trial data, have influenced recommendations for the optimal regimen and duration of dual antiplatelet therapy (DAPT). The statement reviews how these changes alter evidence-based practice, supporting adjustments in DAPT duration and composition according to device type, clinical presentation, and patient risk profile.
Antiplatelet medications continue to be powerful tools to prevent recurrent ischemic events in patients with established ASCVD, particularly among those who have experienced an acute coronary syndrome (ACS). The statement reiterates the central role of antiplatelets in secondary prevention while underscoring the need to tailor therapy by clinical scenario and patient characteristics.
A recurring theme in the statement is the perpetual clinical challenge of balancing ischemic reduction against the risk of bleeding associated with antiplatelet therapy. The authors emphasize that this balance requires individualized treatment decisions that incorporate patient-specific ischemic risk, bleeding risk, comorbid conditions, and concurrent therapies. The report addresses strategies to evaluate and mitigate bleeding risk while preserving antiplatelet efficacy where indicated.
The statement includes focused discussion on antiplatelet use in patients with elevated bleeding risk and in those who require surgical procedures. It summarizes considerations for modifying antiplatelet regimens in these contexts to minimize perioperative bleeding while maintaining protection against ischemic events. Specific management details and recommendations are presented in the full text.
Recognizing heterogeneity among patients with ASCVD, the statement examines antiplatelet strategies across different disease phenotypes. It also reviews scenarios that require concomitant use of antithrombotic medications and discusses how to balance combined therapy indications with bleeding concerns. The report emphasizes individualized approaches when antiplatelets are used alongside other antithrombotic agents.
The scientific statement presents a comparison of current clinical practice guideline–based recommendations and provides a summary of pivotal clinical trials that have shaped contemporary antiplatelet strategies. These comparative and historical perspectives are intended to assist clinicians in understanding the evidence base underlying recommended approaches to antiplatelet therapy in ASCVD.
Long-term monitoring and adherence are addressed as essential components of effective antiplatelet therapy. The statement discusses practical clinical considerations for sustaining appropriate antiplatelet use over time, including monitoring for adverse effects, addressing adherence barriers, and reassessing risk profiles as clinical circumstances change.
This scientific statement was published in the Journal of the American College of Cardiology (J Am Coll Cardiol) with full bibliographic citation: 2026 Sep 15;88(11):1284-1313. DOI 10.1016/j.jacc.2026.05.037. PMID 42377293. Key topics emphasized in the statement include aspirin, dual antiplatelet therapy, acute coronary syndrome, bleeding risk, and broader management of atherosclerotic cardiovascular disease.
Note: The content above summarizes the scope and principal themes reported in the PubMed abstract and related record. Specific trial results, numerical estimates of benefit or harm, and detailed guideline recommendations are presented in the full text of the ACC scientific statement and are not provided in the PubMed abstract.