Guidelines updated for use of antiplatelet therapy for atherosclerotic CVD

In a guideline update issued by the Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology and published online Oct. 28 in the Canadian Journal of Cardiology, new recommendations are presented regarding the use of antiplatelet therapy (APT) for the prevention of atherosclerotic cardiovascular disease.

Kevin R. Bainey, M.D., from the Mazankowski Alberta Heart Institute at the University of Alberta in Edmonton, Canada, and colleagues updated guidelines for the use of APT for primary and secondary prevention of atherosclerotic cardiovascular disease.

The guidelines provide recommendations relating to use of acetylsalicylic acid in primary prevention of atherosclerotic cardiovascular disease; duration of dual APT (DAPT) after percutaneous coronary intervention (PCI) in patients with a high risk for bleeding; choice of potent DAPT (P2Y₁₂ inhibitor) for patients presenting with an acute coronary syndrome (ACS) and possible DAPT de-escalation strategies after PCI; choice and duration of DAPT in patients with ACS who are treated medically, without revascularization; and DAPT pretreatment before coronary angiography.

In addition, recommendations also address perioperative and longer-term APT management for those who need coronary artery bypass grafting surgery, as well as the use of APT for patients with atrial fibrillation who require oral anticoagulation after PCI or ACS with medical management.

"We really focus on individuals and determining their cardiovascular risk, their risk of bleeding, and then tailoring their antiplatelet therapy to maximize the outcomes for them," Bainey said in a statement. "So, it's really taking it to a different level; we're the first in the world to endorse a shared decision-making model, engaging the person who is at risk together with their doctor."