Use of antithrombotic therapy for secondary prevention in patients with stable atherosclerotic cardiovascular disease: Insights from the COordinated National Network to Engage Cardiologists in the antithrombotic Treatment of patients with CardioVascular Disease (CONNECT-CVD) study.

Autor:	Verma S; Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada., Goodman SG; Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.; St Michael's Hospital, University of Toronto, Toronto, ON, Canada.; Canadian Heart Research Centre, Toronto, ON, Canada., Tan MK; Canadian Heart Research Centre, Toronto, ON, Canada., Daneault B; Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada., Lubelsky BJ; North York General Hospital, University of Toronto, Toronto, ON, Canada., Mansour S; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, QC, Canada., Lam AS; West Lincoln Memorial Hospital, Grimsby, ON, Canada., Laflamme D; Hôpital Charles-LeMoyne, Greenfield Park, QC, Canada., Tymchak WJ; University of Alberta Hospital, Edmonton, AB, Canada., Welsh RC; Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada., Rose RC; North York General Hospital, University of Toronto, Toronto, ON, Canada., Chetty RM; Windsor Regional Hospital, Windsor, ON, Canada., Constance CM; Hôpital Maisonneuve Rosemont, Montreal, QC, Canada., Cieza T; Québec Heart and Lung Institute, Université Laval, QC, Canada., Potter BJ; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, QC, Canada., Hartleib MC; Peterborough Regional Health Centre, Peterborough, ON, Canada., Khan R; Royal Columbian Hospital, New Westminster, BC, Canada., Choi RF; St Joseph's Health Centre Toronto, University of Toronto, Toronto, ON, Canada., Keeble W; Misericordia Hospital, University of Alberta, Edmonton, AB, Canada., Dery JP; Québec Heart and Lung Institute, Université Laval, QC, Canada., Shukla D; Health Sciences North, Sudbury, ON, Canada., Chua GL; Mackenzie Health, Richmond Hill, ON, Canada., Bainey KR; Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Jazyk:	angličtina
Zdroj:	International journal of clinical practice [Int J Clin Pract] 2021 Oct; Vol. 75 (10), pp. e14597. Date of Electronic Publication: 2021 Jul 17.
DOI:	10.1111/ijcp.14597
Abstrakt:	Background: Although acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada. Methods: Canadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy-like criteria from May 2018 to April 2019. Results: Of the 492 (two cardiologists provided 11 patients) enroled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularisation was common (percutaneous coronary artery intervention 61%, coronary artery bypass graft 39%), with 31% having multivessel disease. A total of 47% of patients had a Reduction of Atherothrombosis for Continued Health bleeding score of ≥11 (~2.8% risk of serious bleeding at 2 years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC), with 16% being on non-vitamin K oral anticoagulant alone, 5% on DPI and 1% received triple therapy. Conclusions: In contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk. (© 2021 John Wiley & Sons Ltd.)
Databáze:	MEDLINE
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