Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 Focused Update of the Guidelines for the Use of Antiplatelet Therapy

Antiplatelet therapy (APT) is the foundation of treatment and prevention of atherothrombotic events in patients with atherosclerotic cardiovascular disease. Selecting the optimal APT strategies to reduce major adverse cardiovascular events, while balancing bleeding risk, requires ongoing review of c...

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Published in:Canadian journal of cardiology 2024-02, Vol.40 (2), p.160-181
Main Authors: Bainey, Kevin R., Marquis-Gravel, Guillaume, Belley-Côté, Emilie, Turgeon, Ricky D., Ackman, Margaret L., Babadagli, Hazal E., Bewick, David, Boivin-Proulx, Laurie-Anne, Cantor, Warren J., Fremes, Stephen E., Graham, Michelle M., Lordkipanidzé, Marie, Madan, Mina, Mansour, Samer, Mehta, Shamir R., Potter, Brian J., Shavadia, Jay, So, Derek F., Tanguay, Jean-François, Welsh, Robert C., Yan, Andrew T., Bagai, Akshay, Bagur, Rodrigo, Bucci, Claudia, Elbarouni, Basem, Geller, Carol, Lavoie, Andrea, Lawler, Patrick, Liu, Shuangbo, Mancini, John, Wong, Graham C.
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - drug therapy
Canada
Cardiology
Humans
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Systematic Reviews as Topic
Treatment Outcome
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Summary:Antiplatelet therapy (APT) is the foundation of treatment and prevention of atherothrombotic events in patients with atherosclerotic cardiovascular disease. Selecting the optimal APT strategies to reduce major adverse cardiovascular events, while balancing bleeding risk, requires ongoing review of clinical trials. Appended, the focused update of the Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology guidelines for the use of APT provides recommendations on the following topics: (1) use of acetylsalicylic acid in primary prevention of atherosclerotic cardiovascular disease; (2) dual APT (DAPT) duration after percutaneous coronary intervention (PCI) in patients at high bleeding risk; (3) potent DAPT (P2Y12 inhibitor) choice in patients who present with an acute coronary syndrome (ACS) and possible DAPT de-escalation strategies after PCI; (4) choice and duration of DAPT in ACS patients who are medically treated without revascularization; (5) pretreatment with DAPT (P2Y12 inhibitor) before elective or nonelective coronary angiography; (6) perioperative and longer-term APT management in patients who require coronary artery bypass grafting surgery; and (7) use of APT in patients with atrial fibrillation who require oral anticoagulation after PCI or medically managed ACS. These recommendations are all on the basis of systematic reviews and meta-analyses conducted as part of the development of these guidelines, provided in the Supplementary Material. Le traitement antiplaquettaire est la base du traitement et de la prévention des manifestations athérothrombotiques chez les patients atteints d’une maladie cardiovasculaire athéroscléreuse. Le choix du traitement antiplaquettaire approprié pour réduire les événements cardiovasculaires indésirables majeurs, tout en tenant compte du risque de saignement, demande un suivi constant des essais cliniques. En annexe, la mise à jour ciblée des lignes directrices de la Société cardiovasculaire du Canada/Association canadienne de cardiologie d’intervention pour l’utilisation du traitement antiplaquettaire formule des recommandations sur les sujets suivants : 1) l’emploi de l’acide acétylsalicylique dans la prévention primaire des maladies cardiovasculaires athéroscléreuses; 2) la durée de la bithérapie antiplaquettaire après une intervention coronarienne percutanée (ICP) chez les patients qui présentent un risque élevé de saignement; 3) le choix d’une bithérapie antiplaquettaire puissante (inhibi
ISSN:0828-282X
1916-7075
1916-7075
DOI:10.1016/j.cjca.2023.10.013