ACC Issues 2026 Scientific Statement on Antiplatelet Therapy in ASCVD

The American College of Cardiology (ACC) issued a 2026 scientific statement in the June 30 online edition of Journal of the  American College of Cardiology (JACC). The statement outlines current evidence and consensus recommendations for antiplatelet therapy in the management of atherosclerotic cardiovascular disease (ASCVD). The statement addresses antiplatelet use across primary prevention, acute coronary syndrome (ACS), chronic coronary disease, peripheral artery disease (PAD), stroke, transient ischemic attack (TIA), perioperative care, and patients requiring anticoagulation.

According to the ACC, antiplatelet medications remain important tools for preventing ischemic events, particularly after ACS, but treatment decisions require individualized balancing of ischemic risk and bleeding risk. The statement notes that aspirin remains the most widely used antiplatelet drug, although recent data do not support routine aspirin use for primary prevention broadly, with consideration reserved for people at the highest ischemic risk.

For primary prevention, the committee reported that low-dose aspirin might be considered for adults aged 40 to 70 years who have higher cardiovascular risk and no increased bleeding risk, while routine aspirin use in adults older than 70 years should be avoided. The statement also notes that risk calculators may help identify patients at high ischemic risk, but aspirin use in patients with high bleeding risk is associated with net harm regardless of coronary artery calcium score or ASCVD risk.

For patients undergoing percutaneous coronary intervention (PCI), the ACC statement identifies 6 months of dual antiplatelet therapy (DAPT) as the default duration for chronic coronary disease and 12 months for ACS. Shortened DAPT for 1 to 3 months followed by P2Y12 inhibitor monotherapy may reduce bleeding without increasing ischemic events, although the statement says this approach is mainly supported for ticagrelor or prasugrel rather than clopidogrel or aspirin unless the patient has high bleeding risk.

The statement also highlights evolving long-term strategies after ACS or myocardial infarction, including emerging data suggesting clopidogrel monotherapy may provide greater ischemic protection with similar or lower bleeding risk compared with aspirin monotherapy for secondary coronary artery disease prevention. The committee emphasized that intensified strategies may be appropriate for selected high-risk patients, but ischemic benefit should be weighed against increased bleeding risk.

Sources: Kumbhani DJ, Gibson CM, Kinlay S, Peterson ED, Pollak AW, Tamis-Holland JE, Verheugt FWA. Antiplatelet therapy in the management of atherosclerotic cardiovascular disease: 2026 ACC scientific statement: a report of the American College of Cardiology. J Am Coll Cardiol. 2026; Published online June 30, 2026; doi:10.1016/j.jacc.2026.05.037