A 65-year-old man with AF on clopidogrel 75 mg daily asks if he should continue the daily aspirin he was prescribed after MI 2 years ago. What is the best advice?

• A. Continue aspirin alongside clopidogrel indefinitely
• B. Stop clopidogrel and start aspirin
• C. Use both clopidogrel and aspirin as dual therapy
• D. Stop aspirin and take clopidogrel as monotherapy

Answer: (D)

The key idea is balancing protection against coronary events with the risk of bleeding. After the initial post-MI period, continuing both aspirin and a P2Y12 inhibitor (clopidogrel) indefinitely adds bleeding risk without substantial extra benefit for most patients. If clopidogrel is already providing the ongoing antiplatelet protection needed for coronary disease, stopping aspirin reduces bleeding risk while keeping a single antiplatelet agent in place. In this scenario, continuing clopidogrel alone gives safer long-term protection than keeping aspirin alongside it. (Note: atrial fibrillation would typically be managed with anticoagulation for stroke prevention, but focusing on the antiplatelet regimen, stopping aspirin and maintaining clopidogrel alone is the appropriate choice.)