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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Vydáno v:Canadian journal of cardiology Ročník 40; číslo 2; s. 160 - 181
Hlavní autoři: 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.
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Elsevier Inc 01.02.2024
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ISSN:0828-282X, 1916-7075, 1916-7075
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Abstract 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 (inhibiteur de P2Y12) chez les patients qui présentent un syndrome coronarien aigu et les stratégies éventuelles de désescalade de la bithérapie antiplaquettaire après une ICP; 4) le choix et la durée de la bithérapie antiplaquettaire chez les patients atteints du syndrome coronarien aigu qui reçoivent un traitement médical sans revascularisation; 5) le prétraitement par une bithérapie antiplaquettaire (inhibiteur de P2Y12) avant une coronarographie non urgente ou urgente; 6) la prise en charge par un traitement antiplaquettaire périopératoire et à long terme chez les patients qui ont besoin d’un pontage aortocoronarien; et 7) l’utilisation du traitement antiplaquettaire chez les patients qui présentent une fibrillation auriculaire et qui ont besoin d’un traitement anticoagulant par voie orale après une ICP ou qui présentent un syndrome coronarien aigu traité médicalement. Toutes les recommandations reposent sur les analyses des publications et les méta-analyses menées dans le but de formuler ces lignes directrices, fournies dans le matériel supplémentaire.
AbstractList 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 (inhibiteur de P2Y12) chez les patients qui présentent un syndrome coronarien aigu et les stratégies éventuelles de désescalade de la bithérapie antiplaquettaire après une ICP; 4) le choix et la durée de la bithérapie antiplaquettaire chez les patients atteints du syndrome coronarien aigu qui reçoivent un traitement médical sans revascularisation; 5) le prétraitement par une bithérapie antiplaquettaire (inhibiteur de P2Y12) avant une coronarographie non urgente ou urgente; 6) la prise en charge par un traitement antiplaquettaire périopératoire et à long terme chez les patients qui ont besoin d’un pontage aortocoronarien; et 7) l’utilisation du traitement antiplaquettaire chez les patients qui présentent une fibrillation auriculaire et qui ont besoin d’un traitement anticoagulant par voie orale après une ICP ou qui présentent un syndrome coronarien aigu traité médicalement. Toutes les recommandations reposent sur les analyses des publications et les méta-analyses menées dans le but de formuler ces lignes directrices, fournies dans le matériel supplémentaire.
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 (P2Y 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 (P2Y 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.
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.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.
Author Fremes, Stephen E.
Liu, Shuangbo
Lordkipanidzé, Marie
Turgeon, Ricky D.
Graham, Michelle M.
Madan, Mina
Mansour, Samer
Bewick, David
Mehta, Shamir R.
Lawler, Patrick
Mancini, John
Cantor, Warren J.
Bagai, Akshay
So, Derek F.
Welsh, Robert C.
Lavoie, Andrea
Ackman, Margaret L.
Boivin-Proulx, Laurie-Anne
Potter, Brian J.
Yan, Andrew T.
Bagur, Rodrigo
Bucci, Claudia
Bainey, Kevin R.
Geller, Carol
Marquis-Gravel, Guillaume
Babadagli, Hazal E.
Shavadia, Jay
Wong, Graham C.
Tanguay, Jean-François
Belley-Côté, Emilie
Elbarouni, Basem
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  givenname: Warren J.
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  fullname: Cantor, Warren J.
  organization: Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
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  organization: University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  surname: Lordkipanidzé
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  surname: Madan
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  organization: University of Ottawa, Centretown Community Health Centre, Ottawa, Ontario, Canada
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  organization: Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
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  organization: Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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  surname: Wong
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/38104631$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2023 Canadian Cardiovascular Society
Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Snippet Antiplatelet therapy (APT) is the foundation of treatment and prevention of atherothrombotic events in patients with atherosclerotic cardiovascular disease....
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SubjectTerms Acute Coronary Syndrome - drug therapy
Canada
Cardiology
Humans
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Systematic Reviews as Topic
Treatment Outcome
Title Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 Focused Update of the Guidelines for the Use of Antiplatelet Therapy
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