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.
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.
Norwegian Knowledge Centre for the Health Services and Department of Medicine, Innlandet Hospital Trust Gjøvik, Gjøvik, Norway.
Per Olav
PO
Vandvik
Department of Cardiovascular Medicine and Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland Clinic, Cleveland, OH.
A Michael
AM
Lincoff
Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
Joel M
JM
Gore
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
David D
DD
Gutterman
Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ.
Frank A
FA
Sonnenberg
Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain.
Pablo
P
Alonso-Coello
Department of Medicine and Department of Clinical Epidemiology and Biostatistics, State University of New York at Buffalo, Buffalo, NY.
Elie A
EA
Akl
Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA.
Maarten G
MG
Lansberg
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
Gordon H
GH
Guyatt
Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: fspence@mcmaster.ca.
Frederick A
FA
Spencer
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008134:Long-Term Care; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D012955:Societies, Medical; D015607:Stents; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors