Coronary Stent Post-Procedure Care: DAPT, Lifestyle & Follow-Up Protocol

Stent implantation (PCI) requires structured aftercare to prevent stent thrombosis (ST), restenosis, and recurrent events. Protocol differs for BMS (bare metal) vs DES (drug-eluting) stents.

Antiplatelet Therapy (DAPT) – CRITICAL

Stent Type	Minimum DAPT Duration	Preferred Duration	Regimen
BMS	1 month	1 month	Aspirin 81 mg + Clopidogrel 75 mg (or Ticagrelor 90 mg BID / Prasugrel 10 mg)
DES (1st gen)	6 months	12 months	Same
DES (2nd/3rd gen)	3-6 months	6-12 months (per bleeding risk)	Same
High Bleeding Risk (HBR)	1-3 months	3-6 months	De-escalation strategies (Aspirin + Ticagrelor 60mg, or monotherapy after 1-3 mo)

NEVER STOP DAPT WITHOUT CARDIOLOGIST APPROVAL. ST mortality 40-50%.

Post-PCI Immediate Care (First 24-48h)

• Access Site: Radial (95%+): TR band 2-4h; ambulate 2-4h. Femoral: bedrest 4-6h, closure device vs manual compression.
• Monitoring: Telemetry, vitals q15min x1h, q30min x2h, q1h x4h. Access site q15min x1h.
• Hydration: 2-3L IV/PO for contrast clearance (if eGFR <60, NAC protocol).
• Medications: Load DAPT if not pre-loaded. Statin high-intensity (atorvastatin 40-80mg). ACEi/ARB if EF<40%. Beta-blocker if MI.

Activity Progression

Timeline	Restrictions
Days 1-2	No lifting >5 lbs (radial) / >10 lbs (femoral). No straining. Short walks.
Days 3-7	Light activity. No vigorous exercise. Driving OK if radial (24h) / femoral (48h) & off opioids.
Week 2-4	Cardiac rehab Phase II (supervised). Gradual aerobic progression.
Month 1+	Unrestricted if uncomplicated. Competitive sports: cardiologist clearance.

Follow-Up Schedule

• 1 week: Access site, medication reconciliation, symptom review.
• 1 month: Labs (CBC, BMP, lipids, HbA1c), ECG, medication titration.
• 3 months: Stress test if indicated (ischemia-guided).
• 6-12 months: Consider functional testing if high-risk anatomy.
• Annual: Lipids, glucose, renal function, medication review.

Lifestyle Modifications (Class I Recommendations)

• Diet: Mediterranean/DASH; <7% saturated fat; <200mg cholesterol; 30g fiber.
• Exercise: 150 min moderate / 75 min vigorous weekly + resistance 2x/wk.
• Smoking: Complete cessation (varenicline/bupropion + counseling).
• BP: <130/80 (ACC/AHA).
• Lipids: LDL <70 mg/dL (very high risk) / <55 mg/dL (extreme risk); high-intensity statin ± ezetimibe/PCSK9i.
• Diabetes: HbA1c <7%; SGLT2i/GLP-1 RA for cardio-renal benefit.

Red Flags (Immediate ER)

• Chest pain >20 min unrelieved by 3x NTG
• Sudden dyspnea, syncope
• Access site: rapid swelling, hematoma expansion, pulsatile mass
• Stroke symptoms (FAST)
• Melena/hematochezia (GI bleed on DAPT)