title: The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines.
abstract: Antiplatelet agents are a cornerstone of therapy for patients with atherosclerotic vascular disease. There is presently a lack of comprehensive guidelines focusing on the use of antiplatelet drugs in patients currently manifesting or at elevated risk of cardiovascular disease. The Canadian Antiplatelet Therapy Guidelines Committee reviewed existing disease-based guidelines and subsequently published literature and used expert opinion and review to develop guidelines on the use of antiplatelet therapy in the outpatient setting. This full document has been summarized in an Executive Summary published in the Canadian Journal of Cardiology and may be found at http://www.ccs.ca/. Antiplatelet therapy appears to be generally underused, perhaps in part because of a lack of clear, evidence-based guidance. Here, we provide specific guidelines for secondary prevention in patients discharged from hospital following acute coronary syndromes, post-percutaneous coronary intervention, post-coronary artery bypass grafting, patients with a history of transient cerebral ischemic events or strokes, and patients with peripheral arterial disease. Issues related to primary prevention are also addressed, in addition to special clinical contexts such as diabetes, heart failure, chronic kidney disease, pregnancy/lactation, and perioperative management. Recommendations are provided regarding pharmacologic interactions that may occur during combination therapy with warfarin, clopidogrel and proton-pump inhibitors, or acetylsalicylic acid and nonsteroidal anti-inflammatory drugs, as well as for the management of bleeding complications.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Bell
authors.forename: André
authors.initials: A
authors.lastname: Roussin
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Wee Shian
authors.initials: WS
authors.lastname: Chan
authors.forename: James D
authors.initials: JD
authors.lastname: Douketis
authors.forename: Anil
authors.initials: A
authors.lastname: Gupta
authors.forename: Maria E
authors.initials: ME
authors.lastname: Kraw
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lindsay
authors.forename: Michael P
authors.initials: MP
authors.lastname: Love
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Philip
authors.initials: P
authors.lastname: Teal
authors.forename: Pierre
authors.initials: P
authors.lastname: Théroux
authors.forename: Alexander G G
authors.initials: AG
authors.lastname: Turpie
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
mesh_terms: D002170:Canada; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012955:Societies, Medical
chemical_list: D010975:Platelet Aggregation Inhibitors