A Critical Comparison of Canadian and International Guidelines Recommendations for Antiplatelet Therapy in Coronary Artery Disease.

Journal Article (Journal Article;Review)

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.

Full Text

Duke Authors

Cited Authors

  • Marquis-Gravel, G; Mehta, SR; Valgimigli, M; Levine, GN; Neumann, F-J; Granger, CB; Costa, F; Lordkipanidzé, M; Roffi, M; Robinson, SD; Cantor, WJ; Tanguay, J-F

Published Date

  • August 2020

Published In

Volume / Issue

  • 36 / 8

Start / End Page

  • 1298 - 1307

PubMed ID

  • 32553812

Electronic International Standard Serial Number (EISSN)

  • 1916-7075

Digital Object Identifier (DOI)

  • 10.1016/j.cjca.2019.12.013

Language

  • eng

Conference Location

  • England