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Leadership. Knowledge. Community. Guideline Pearls Canadian Cardiovascular Society Antiplatelet Guidelines
Objective To interpret a quick summary of the key “takeaways” from the Canadian Cardiovascular Society Antiplatelet Guidelines. © TIGC
Guideline Pearls Do’s and Don’ts Primary prevention DODON’T Consider ASA only where there is clear evidence of high risk. Asymptomatic carotid stenosis Asymptomatic coronary atherosclerosis Reduced ABI Use antiplatelet therapy for primary prevention. © TIGC
Guideline Pearls Do’s and Don’ts Cerebrovascular disease Provide lifetime antiplatelet Rx to all patients post ischemic stroke or TIA. Consider DAPT with ASA + Clopidogrel in patients with high risk TIA or minor stroke for 30 days. Use DAPT with ASA + Clopidogrel for long term secondary stroke prevention. © TIGC DODON’T
Guideline Pearls Do’s and Don’ts ACS/PCI Provide lifetime antiplatelet Rx to all patients post ACS with or without PCI. Provide DAPT with ASA + P2Y12 inhibitor to all ACS patients. Know the type of stent your patient has inserted. Consider DAPT beyond 1 year in patients with high risk of thrombosis and low risk of bleeding. Use doses of ASA above 75 – 162 mg. Discontinue DAPT prior to 1 yr without a very good reason. EVER discontinue DAPT in a patient with a Drug Eluting Stent prior to 1 yr, EVER. DODON’T © TIGC
Guideline Pearls Do’s and Don’t’s Management of patients post ACS who require surgery, diagnostic or dental procedures Delay such procedures in patients taking DAPT. Stop clopidogrel for 7-10 days prior if it can be done so safely. Stop ASA for 7 – 10 days for bleeding high risk surgical procedures. Discontinue DAPT prior to 1 year in patients with Drug Eluting Stents EVER. Stop ASA for minor procedures including: Arthrocentesis Dental procedures Cataract surgery Skin excisions © TIGC DODON’T
Minor bleeding management Stop antiplatelet therapy for: Eccymosis Petechia Subconjunctival hemorrhage Epistaxis Dental / gingival bleeding tranexamic acid mouthwash If persistent check: Complete blood count INR and activated Partial thromboplastin time (aPTT) Guideline Pearls Do’s and Don’t’s DODON’T © TIGC
Drug interactions Use PPI’s that inhibit CYP2C19 in patients taking clopidogrel or prasugrel. Use NSAIDs or Coxibs in patients at increased risk of vascular events. Use Coxibs over traditional NSAIDs in patients taking ASA for CV prevention but only if absolutely necessary. Guideline Pearls Do’s and Don’t’s DODON’T © TIGC
Leadership. Knowledge. Community. Canadian Cardiovascular Society Antiplatelet Guidelines PERIOPERATIVE MANAGEMENT OF ANTIPLATELET THERAPY Working Group:
Leadership. Knowledge. Community. Antiplatelet Therapy for the Primary Prevention of Vascular Events Working Group: Alan D. Bell, MD, CCFP and James D.
RECOMMENDATIONS Canadian Cardiovascular Society Anti Platelet Guideline 2010 Alan D. Bell, MD, CCFP; Raymond Cartier, MD; Wee Shian Chan, MD, FRCP; James.
Sticky Issues with Antiplatelet Therapy Goal Have an understanding, based on a review of current literature, on how to manage patients on antiplatelet.
Leadership. Knowledge. Community. Antiplatelet Therapy for Secondary Prevention in the First Year Following an Acute Coronary Syndrome Working Group: Jean-François.
EBM Chengyu (Cheryl) Xu March, 2012 ACS trials. Outline – over 70 ACS trials Mangement strategy Cardiogenic shock Lytics/Referfusion Stable CAD/Elective.
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A Guideline for Healthcare Professionals From the American Heart Association & American Stroke Association Metrics for Measuring Quality of Care in Comprehensive.
1 US Investigator Meeting DIAS-4, Chicago, July 2011 DIAS-4-USA Study Protocol.
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Debbie L. Cardell, MD Div Gen Med UTHSCSA2/29/08 Anticoagulation Debbie L. Cardell, MD Asst. Clinical Prof of Medicine Medical Director UHC-D Anticoagulation.
Advances in Prevention and Treatment of Stroke 2008 S. Andrew Josephson, MD The speaker has no disclosures Department of Neurology, Neurovascular Division.
Secondary prevention of MI. Sep 2003Dr. Sooraj Natarajan Ischaemic heart disease May be broadly defined to include Myocardial infarction Myocardial infarction.
KAVITHA KANAKANTI. To confirm the number of patients who were on Clopidogrel are taking Proton Pump Inhibitors.
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