A Critical Comparison of Canadian and International Guidelines Recommendations for Antiplatelet Therapy in Coronary Artery Disease
| Autor: | Glenn N. Levine, Guillaume Marquis-Gravel, Marie Lordkipanidzé, Shamir R. Mehta, Marco Valgimigli, Francesco Costa, Simon D. Robinson, Warren J. Cantor, Franz-Josef Neumann, Jean-François Tanguay, Christopher B. Granger, Marco Roffi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Canada
medicine.medical_specialty medicine.medical_treatment MEDLINE Coronary Artery Disease 030204 cardiovascular system & hematology Coronary artery disease 03 medical and health sciences 0302 clinical medicine P2Y12 Guidelines recommendations medicine Humans cardiovascular diseases 030212 general & internal medicine Intensive care medicine Aspirin business.industry Percutaneous coronary intervention Clopidogrel medicine.disease 3. Good health Europe Concomitant Practice Guidelines as Topic Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Canadian Journal of Cardiology. 36:1298-1307 |
| ISSN: | 0828-282X |
| DOI: | 10.1016/j.cjca.2019.12.013 |
| Popis: | Antiplatelet therapy for patients with coronary artery disease has evolved dramatically over the last decade. P2Y12 inhibitors offering more potent and consistent platelet inhibition than clopidogrel are now widely available, dual antiplatelet therapy (DAPT) duration can be tailored to individual ischemic and bleeding risks, and strategies to personalize antiplatelet therapy have been developed when concomitant oral anticoagulation (OAC) is indicated. Scientific societies from Canada, the United States, and Europe have all published updated recommendations addressing antiplatelet therapy in the recent years. The purpose of this review is to put the Canadian guidelines into perspective vis-à-vis international recommendations by highlighting similarities and critically analyzing differences. We focus on 3 major topics relevant for clinical practice: DAPT duration following drug-eluting stent implantation, DAPT following percutaneous coronary intervention in patients with concomitant indications for OAC, and DAPT management for noncardiac surgery following drug-eluting stent implantation. Although guidelines broadly agree on the majority of recommendations, the justifications for major differences were contrasted in the manuscript. Unanswered questions remain, including the place of aspirin in secondary prevention of coronary artery disease in the contemporary era, aspirin-free strategies early after percutaneous coronary intervention, and the safe minimal duration of DAPT with newer generation stents. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect