Write the stop date on the second antiplatelet

The commonest antithrombotic harm in a patient with atrial fibrillation after a stent is not the wrong initial choice. It is triple therapy that nobody stopped. The interventionist intends four weeks, the discharge letter says 'continue current medication', the general practitioner reissues it, and a year later the patient is still on an anticoagulant plus two antiplatelets with no one having decided that they should be.

The fix is a sentence, and it belongs in the discharge summary rather than in anyone's memory. Name the drug, name the date it stops, and name who is responsible for stopping it. 'Clopidogrel 75 mg once daily, stop on 4 October 2026, primary care to discontinue' is unambiguous in a way that 'short course of triple therapy' is not. Do the same for the P2Y12 inhibitor's own end date when the plan is for the anticoagulant to continue alone.

Then close the loop by asking at the next clinic visit what the patient is actually taking, tablet by tablet, rather than reading the list back to them. Patients rarely volunteer that they are still on something; they assume that if it is in the box, someone meant it to be.

• Put an explicit stop date for each antiplatelet in the discharge summary, not a duration.
• Name who is responsible for stopping it - the interventional team, the clinic, or primary care.
• At each review, ask the patient to list what they take rather than confirming your list.
• Reconcile against the repeat prescription, which is where an unstopped drug survives.
• Record the intended end state - anticoagulant alone, or anticoagulant plus one antiplatelet - so a deviation is visible.

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