Primary and Secondary Prevention of Cardiovascular Disease Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Por:
Vandvik, O, Lincoff, AM, Gore, JM, Gutterman, DD, Sonnenberg, FA, Alonso-Coello, P, Akl, EA, Lansberg, MG, Guyatt, GH, Spencer, FA
Publicada:
1 feb 2012
Resumen:
Background: This guideline focuses on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies.
Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.
Results: We present 23 recommendations for pertinent clinical questions. For primary prevention of cardiovascular disease, we suggest low-dose aspirin (75-100 mg/d) in patients aged >50 years over no aspirin therapy (Grade 2B). For patients with established coronary artery disease, defined as patients 1-year post-acute coronary syndrome, with prior revascularization, coronary stenoses >50% by coronary angiogram, and/or evidence for cardiac ischemia on diagnostic testing, we recommend long-term low-dose aspirin or clopidogrel (75 mg/d) (Grade 1A). For patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI) with stent placement, we recommend for the first year dual antiplatelet therapy with low-dose aspirin in combination with ticagrelor 90 mg bid, clopidogrel 75 mg/d, or prasugrel 10 mg/d over single antiplatelet therapy (Grade 1B). For patients undergoing elective PCI with stent placement, we recommend aspirin (75-325 mg/d) and clopidogrel for a minimum duration of 1 month (bare-metal stents) or 3 to 6 months (drug-eluting stents) (Grade 1A). We suggest continuing low-dose aspirin plus clopidogrel for 12 months for all stents (Grade 2C). Thereafter, we recommend single antiplatelet therapy over continuation of dual antiplatelet therapy (Grade 1B).
Conclusions: Recommendations continue to favor single antiplatelet therapy for patients with established coronary artery disease. For patients with acute coronary syndromes or undergoing elective PCI with stent placement, dual antiplatelet therapy for up to 1 year is warranted.
Filiaciones:
Vandvik, O:
Innlandet Hosp Trust Gjovik, Norwegian Knowledge Ctr Hlth Serv, Gjovik, Norway
Innlandet Hosp Trust Gjovik, Dept Med, Gjovik, Norway
Lincoff, AM:
Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA
Cleveland Clin, Cleveland Clin Coordinating Ctr Clin Res C5Res, Cleveland, OH 44106 USA
Gore, JM:
Univ Massachusetts, Sch Med, Dept Med, Worcester, MA USA
Gutterman, DD:
Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA
Sonnenberg, FA:
Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ 08903 USA
Alonso-Coello, P:
CIBERESP IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Akl, EA:
SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA
SUNY Buffalo, Dept Clin Epidemiol & Biostat, Buffalo, NY 14260 USA
Lansberg, MG:
Stanford Univ, Med Ctr, Stanford Stroke Ctr, Palo Alto, CA 94304 USA
Guyatt, GH:
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Spencer, FA:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Green Published
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