Focused 2012 Update of the Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy

Tanguay, Jean‐François; Bell, Alan; Ackman, Margaret L.; Bauer, Robert D.C.; Cartier, Raymond; Chan, Wee‐Shian; Douketis, James D.; Roussin, André; Schnell, Gregory; Verma, Subodh; Wong, Graham C.; Mehta, Shamir R.

doi:10.1016/j.cjca.2013.07.001

Cited by 96 publications

(86 citation statements)

References 69 publications

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“…If aspirin discontinuation is deemed necessary, a delay of no more than 3-5 days is suggested [70]. Based on expert opinions, pharmacodynamics and clinical studies, the optimal duration for anti-P2Y12 discontinuation that leads to sufficient platelet function recovery should be 5 days for clopidogrel and ticagrelor, and 7 days for prasugrel [71][72][73].…”

Section: Current Recommendationsmentioning

confidence: 99%

How to manage prasugrel and ticagrelor in daily practice

Bonhomme¹,

Fontana²,

Reny³

2014

European Journal of Internal Medicine

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Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk.

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Section: Current Recommendationsmentioning

confidence: 99%

How to manage prasugrel and ticagrelor in daily practice

Bonhomme¹,

Fontana²,

Reny³

2014

European Journal of Internal Medicine

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“…8,24,25 Prasugrel is an option for dual antiplatelet therapy with ASA, but it does not offer an advantage over clopidogrel and its use in this situation is not encouraged by the guidelines. 8,24,25 Current guidelines recommend that these new antiplatelet agents be considered in patients who experience coronary stent thrombosis while taking dual antiplatelet therapy with ASA and clopidogrel. 25 However, this recommendation is largely based on expert opinion, consensus guidelines and extrapolation from the recent antiplatelet trials.…”

Section: Reviewmentioning

confidence: 99%

“…If prasugrel use is necessary, Canadian and US guidelines recommend that a lower maintenance dose of 5 mg/d be used in such patients to minimize the risk of bleeding. 24,25 This recommendation is largely based on pharmacokinetic studies and has not been clinically validated.…”

Section: Reviewmentioning

confidence: 99%

“…8,24,25 For patients whose condition is medically managed and those undergoing percutaneous coronary intervention without a coronary stent, the guidelines strongly recommend the use of dual antiplatelet therapy with ASA and either clopidogrel or ticagrelor. 8,24,25 Prasugrel is an option for dual antiplatelet therapy with ASA, but it does not offer an advantage over clopidogrel and its use in this situation is not encouraged by the guidelines. 8,24,25 Current guidelines recommend that these new antiplatelet agents be considered in patients who experience coronary stent thrombosis while taking dual antiplatelet therapy with ASA and clopidogrel.…”

Section: Reviewmentioning

confidence: 99%

“…8,24,25 Current guidelines recommend that these new antiplatelet agents be considered in patients who experience coronary stent thrombosis while taking dual antiplatelet therapy with ASA and clopidogrel. 25 However, this recommendation is largely based on expert opinion, consensus guidelines and extrapolation from the recent antiplatelet trials.…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

New antiplatelet agents for cardiovascular disease

Chua

Nishi

2013

CMAJ

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Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022

MacDonald,

Turgeon

2023

JAMA Netw Open

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ImportanceShared decision-making (SDM) is a key component of the provision of ethical care, but prior reviews have indicated that clinical practice guidelines seldom promote or facilitate SDM. It is currently unknown whether these findings extend to contemporary cardiovascular guidelines.ObjectiveTo identify and characterize integration of SDM in contemporary cardiovascular guideline recommendations using a systematic classification system.Design, Setting, and ParticipantsThis cross-sectional study assessed the latest guidelines or subsequent updates that included pharmacotherapy recommendations and were published between January 2012 and December 2022 by the American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC). Data were analyzed from February 21 to July 21, 2023.Main Outcomes and MeasuresAll pharmacotherapy recommendations were identified within each guideline. Recommendations that incorporated SDM were rated according to a systematic rating framework to evaluate the quality of SDM incorporation based on directness (range, 1-3; assessing whether SDM was incorporated directly and impartially into the recommendation’s text, with 1 indicating direct and impartial incorporation of SDM into the recommendation’s text) and facilitation (range, A-D; assessing whether decision aids or quantified benefits and harms were provided, with A indicating that a decision aid quantifying benefits and harms was provided). The proportion of recommendations incorporating SDM was also analyzed according to guideline society and category (eg, general cardiology, heart failure).ResultsAnalyses included 65 guideline documents, and 33 documents (51%) incorporated SDM either in a general statement or within specific recommendations. Of 7499 recommendations, 2655 (35%) recommendations addressed pharmacotherapy, and of these, 170 (6%) incorporated SDM. By category, general cardiology guidelines contained the highest proportion of pharmacotherapy recommendations incorporating SDM (86 of 865 recommendations [10%]), whereas heart failure and myocardial disease contained the least (9 of 315 recommendations [3%]). The proportion of pharmacotherapy recommendations incorporating SDM was comparable across societies (ACC: 75 of 978 recommendations [8%]; CCS: 29 of 333 recommendations [9%]; ESC: 67 of 1344 recommendations [5%]), with no trend for change over time. Only 5 of 170 SDM recommendations (3%) were classified as grade 1A (impartial recommendations for SDM supported by a decision aid), whereas 114 of 170 recommendations (67%) were grade 3D (SDM mentioned only in supporting text and without any tools or information to facilitate SDM).Conclusions and RelevanceIn this cross-sectional study across guidelines published by 3 major cardiovascular societies over the last decade, 51% of guidelines mentioned the importance of SDM, yet only 6% of recommendations incorporated SDM in any form, and fewer adequately facilitated SDM.

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Focused 2012 Update of the Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy

Cited by 96 publications

References 69 publications

How to manage prasugrel and ticagrelor in daily practice

How to manage prasugrel and ticagrelor in daily practice

New antiplatelet agents for cardiovascular disease

Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022

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