Dual Antiplatelet Therapy

What does dual antiplatelet therapy (DAPT) treat?

Dual antiplatelet therapy (DAPT) is a combination of two types of medications — aspirin and a P2Y12 inhibitor —that can prevent blood clots.

Blood clots can help prevent excessive bleeding. But if blood clots form within blood vessels, they can travel to your heart and cause a heart attack. If one travels to your brain, it can cause a stroke.

How does DAPT work?

Platelets are small pieces of cells in your blood. They clump together to form blood clots when a blood vessel is damaged. Antiplatelet medications are drugs that stop platelets from clumping together into blood clots. They can prevent blood clots in your blood vessels, which is a condition called thrombosis.

Who should use dual antiplatelet therapy?

Healthcare providers often prescribe DAPT for people who’ve had certain health events and are at risk for another:

• Heart attack (myocardial infarction).
• Stroke.
• Transient ischemic attack (TIA), also called a mini-stroke.

This therapy is also commonly used to prevent thrombosis in people who've had heart procedures such as:

• Coronary artery bypass surgery, which reroutes blood around a clogged artery.
• Angioplasty, a procedure to widen an artery using a tiny balloon.
• Stent placement to prop open clogged arteries.

What are the DAPT medications?

DAPT combines aspirin and a P2Y12 inhibitor such as:

• Clopidogrel.
• Prasugrel.
• Ticagrelor.

Your healthcare provider will determine the type of P2Y12 inhibitor and the dosage that's right for you.

How effective is dual antiplatelet therapy?

Many studies have shown that DAPT can be more effective than single-antiplatelet therapy to prevent blood clots.

What are the benefits of using DAPT?

Dual antiplatelet therapy decreases the risk of blood clots, heart attack and stroke.

What are the risks of dual antiplatelet therapy?

People taking DAPT are at risk for bleeding complications. The most common type of bleeding is gastrointestinal bleeding. Rarely, people on DAPT can experience bleeding inside their skull. In addition, people taking DAPT can bleed excessively after a fall or a cut.

Can you overdose on dual antiplatelet therapy?

Overdose is possible, so make sure you take all medications exactly as prescribed. Call your healthcare provider if you accidentally take too much at the same time.

What side effects can DAPT cause?

Some people taking DAPT can experience side effects including:

• Difficulty breathing.
• Blood in the urine (hematuria).
• Bruising.
• Low levels of platelets in the blood (thrombocytopenia).
• Nasal polyps.
• Nosebleeds (epistaxis).

What interactions should I watch out for?

DAPT can interact with other medications such as:

• Anticoagulants (blood thinners).
• Antidepressants.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Proton pump inhibitors, which are used to treat GERD (gastroesophageal reflux disease).

Tell your healthcare provider about all the medications you take, including prescriptions, over-the-counter drugs and supplements.

How long will I need DAPT?

Dual antiplatelet therapy duration depends on several factors:

• Age and overall health.
• Bleeding risk.
• Risk for future heart attack or stroke.
• Why you started dual antiplatelet therapy in the first place.

Although some people may take DAPT for only a month or two, many take the medications for a year or longer. Even after DAPT is complete, your healthcare provider may recommend aspirin therapy for life.

Who shouldn't use DAPT?

Before prescribing dual antiplatelet therapy, your healthcare provider will make sure it's safe for you. DAPT may not be right for you if you:

• Are at a high risk of falls.
• Are on dialysis for end-stage kidney disease.
• Are taking other medications that would interact.
• Have a bleeding disorder, such as stomach ulcer or bleeding in your brain.
• Have esophageal varices (enlarged veins in your esophagus).
• Have had a stroke in the last two years.
• Have very high blood pressure or thrombocytopenia (low number of platelets).

How can I keep myself safe on DAPT?

It’s important to follow your healthcare provider’s instructions and take other steps to keep yourself safe:

• Take all medications exactly as prescribed. If you miss a dose or stop taking one of the medications, you could develop a clot.
• Wear an emergency medical ID (such as a bracelet). This will help others realize that you’re undergoing DAPT. The ID should include the name of your medications, along with your and your provider’s contact information.
• Tell all of your healthcare providers that you’re taking DAPT, including your dentist. You may have to stop taking DAPT before medical or dental procedures.

When should I seek medical attention while taking dual antiplatelet therapy?

Call your healthcare provider immediately if you experience any signs of bleeding including:

• Abdominal pain.
• Black poop or blood in your poop.
• Chest pain.
• Confusion.
• Dizziness, lightheadedness or fainting.
• Vomiting blood (blood may be red or brown, or it may look like coffee grounds).
• Severe, sudden headache.
• Trouble breathing.

A note from Cleveland Clinic

Dual antiplatelet therapy (DAPT) is a treatment to prevent blood clots that can cause a heart attack or stroke. It combines aspirin and a P2Y12 inhibitor. If you’re taking DAPT, take all your medications as prescribed and be aware of the signs of bleeding.