# A 62-year-old client is being discharged 3 days after a successful percutaneous coronary intervention with a drug-eluting stent (DES) in the left anterior descending artery. The provider has prescribed aspirin 81 mg daily plus ticagrelor 90 mg twice daily as dual antiplatelet therapy. Which teaching by the nurse is most important? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=374997&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PA ## Question A 62-year-old client is being discharged 3 days after a successful percutaneous coronary intervention with a drug-eluting stent (DES) in the left anterior descending artery. The provider has prescribed aspirin 81 mg daily plus ticagrelor 90 mg twice daily as dual antiplatelet therapy. Which teaching by the nurse is most important? ## Option 1. To reduce the risk of gastrointestinal bleeding, take the aspirin with a full meal and a histamine-2 receptor antagonist such as famotidine 20 mg twice daily; if you develop heartburn or nausea, you may safely substitute ibuprofen 200 mg for aspirin since it also prevents clotting, and report any abdominal pain to your provider. 2. Continue both medications consistently for the duration prescribed (commonly 6-12 months for DES, often 12 months after ACS); never stop the P2Y12 inhibitor on your own; notify any provider — including dentists — about the stent and DAPT before any procedure so timing can be coordinated; report any new bleeding promptly. **✔ Correct answer** 3. Because drug-eluting stents have a lower restenosis rate, you can discontinue the dual antiplatelet therapy after one week to minimize your chance of developing a major hemorrhage; if you notice any bruising or bleeding gums, you may switch to aspirin alone for the remaining recovery period. 4. To simplify your medication schedule, you may take the entire daily dose of ticagrelor (180 mg) as a single dose with your morning meal; this maintains antiplatelet coverage and reduces the risk of missing the second dose, which is a common cause of stent thrombosis, and is preferred by many patients for simplicity. **Correct answer: 2** ## Explanation DAPT after DES — duration and procedural management Dual antiplatelet therapy (aspirin + a P2Y12 inhibitor) is the cornerstone after PCI to prevent stent thrombosis, a catastrophic event with high mortality. Standard durations (subject to bleeding/ischemic risk individualization): • Stable CAD with DES: at least 6 months DAPT, then aspirin lifelong. • ACS (NSTEMI/STEMI) with PCI: at least 12 months DAPT, then aspirin lifelong; longer in high-ischemic risk. • Bare-metal stent: 1 month minimum (rarely used now). Premature discontinuation is the strongest predictor of stent thrombosis. Patient teaching: • Never self-stop the P2Y12 inhibitor; notify all providers (PCP, dentist, surgeon, urgent care) before any procedure so timing can be coordinated with cardiology. • Carry a wallet card with stent type, location, date, and DAPT plan. • Routine dental cleanings and minor procedures usually do not require holding DAPT. • Major surgery may require an interruption with bridge plan; ideally elective surgery is delayed until completion of DAPT (≥6-12 months for DES). • Ticagrelor specifics: BID dosing (every 12 hours); aspirin maintenance dose limited to ≤100 mg (higher aspirin reduces ticagrelor benefit); common adverse: dyspnea (~14%), bradyarrhythmia, increased uric acid; do not co-administer with strong CYP3A4 inhibitors. • Bleeding precautions and immediate reporting (black stool, hemoptysis, severe headache, fall). ## In-depth explanation Clinical reasoning summary DAPT after DES — duration and procedural management Dual antiplatelet therapy (aspirin + a P2Y12 inhibitor) is the cornerstone after PCI to prevent stent thrombosis, a catastrophic event with high mortality. Standard durations (subject to bleeding/ischemic risk individualization): • Stable CAD with DES: at least 6 months DAPT, then aspirin lifelong. • ACS (NSTEMI/STEMI) with PCI: at least 12 months DAPT, then aspirin lifelong; longer in high-ischemic risk. • Bare-metal stent: 1 month minimum (rarely used now). Premature discontinuation is the strongest predictor of stent thrombosis. Patient teaching: • Never self-stop the P2Y12 inhibitor; notify all providers (PCP, dentist, surgeon, urgent care) before any procedure so timing can be coordinated with cardiology. • Carry a wallet card with stent type, location, date, and DAPT plan. • Routine dental cleanings and minor procedures usually do not require holding DAPT. • Major surgery may require an interruption with bridge plan; ideally elective surgery is delayed until completion of DAPT (≥6-12 months for DES). • Ticagrelor specifics: BID dosing (every 12 hours); aspirin maintenance dose limited to ≤100 mg (higher aspirin reduces ticagrelor benefit); common adverse: dyspnea (~14%), bradyarrhythmia, increased uric acid; do not co-administer with strong CYP3A4 inhibitors. • Bleeding precautions and immediate reporting (black stool, hemoptysis, severe headache, fall). ## Related questions - [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=en) - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. 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