skip to main content

DAPT Step-Down Post-PCI CKD Bleeding — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic Kidney DiseaseDAPT Step-Down Post-PCI CKD BleedingESENeph

A 62-year-old man with CKD G4 (eGFR 18 mL/min/1.73m2) has stable cardiovascular disease and is on aspirin, clopidogrel (post-PCI 8 months ago), ramipril, atorvastatin, and bisoprolol. He reports frequent bruising and a GI bleed requiring transfusion. What medication change is MOST appropriate to reduce bleeding risk?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop clopidogrel (>6 months post-PCI) and continue aspirin alone

This patient is >6 months post-PCI, beyond the minimum recommended duration for dual antiplatelet therapy (DAPT) in most scenarios. Stepping down to single antiplatelet therapy (aspirin alone) reduces bleeding risk significantly while maintaining cardiovascular protection. In CKD, bleeding risk is amplified by uraemic platelet dysfunction, and the bleeding:benefit ratio of prolonged DAPT shifts unfavourably. A PPI should be added for gastroprotection regardless. The decision to stop clopidogrel vs aspirin depends on stent type and clinical context, but standard practice is to continue aspirin long-term and stop clopidogrel after 6-12 months. Cardiology input should confirm the timing is appropriate.

Reference: NICE 2020 – NG185 ACS; ESC 2017 – DAPT Guidelines; KDIGO 2024 – CKD Cardiovascular