Antiplatelet Therapy for Secondary Prevention After Acute Myocardial Infarction.

Patients with prior myocardial infarction (MI) are at long-term heightened risk for recurrent ischemic events. Several large randomized controlled trials have demonstrated the benefit of more intensive antiplatelet strategies for long-term secondary prevention of cardiovascular death, recurrent MI, and stroke in patients with a history of MI at a cost of increased bleeding. The bleeding risk associated with long-term intensive antiplatelet strategies requires careful patient selection and involvement of patients in shared decision making regarding risks and benefits of therapy. Clinical characteristics, adherence to therapy, and integrated risk scores may aid clinicians in translating clinical trials into individualized therapy.