New guidelines on antiplatelet therapy have been published by the Canadian Cardiovascular Society (CCS) in collaboration with the Canadian Association of Interventional Cardiology (CAIC). The recommendations are based on the latest evidence and are intended for clinical practitioners.
The CCS/CAIC Expert Panel reviewed the latest evidence and made changes to the 2018 recommendations for antiplatelet therapy. The updated guidelines were presented at a joint meeting and published in the Canadian Journal of Cardiology.
The main purpose of the new document is to provide a choice of optimal antiplatelet therapy strategies to reduce the risk of serious adverse cardiovascular events and bleeding associated with the use of drugs in this group.
The guide provides recommendations on seven topics. Of greatest interest is the change in the recommendation for the routine use of aspirin for the prevention of complications of coronary heart disease. For the first time, daily aspirin is not recommended for all patients, but only for people at high risk of ischemic heart complications.
Other recommendations cover the following issues.
- Duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) in patients at high risk of bleeding.
- Possible choice of dual antiplatelet therapy (P2Y12 inhibitor) in patients with acute coronary syndrome (ACS) and possible dose reduction strategies after PCI.
- Selection and duration of dual antiplatelet therapy in patients with ACS receiving only drug therapy without revascularization.
- Prophylactic use of dual antiplatelet therapy (P2Y12 inhibitor) before elective or emergency coronary angiography.
- Perioperative and long-term use of antiplatelet agents in patients requiring coronary artery bypass grafting.
- The use of antiplatelet agents for atrial fibrillation requiring oral anticoagulants after PCI or drug treatment of ACS.
The new guide will be covered in more detail in the review of the “Clinician School”.