ACC, AHA release updated guidelines on dual antiplatelet therapy in patients with coronary artery disease

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The American College of Cardiology (ACC) and American Heart Association (AHA) released updated guidelines on March 29 on the use of dual antiplatelet therapy in patients with coronary artery disease.

The guidelines were published online in the Journal of the American College of Cardiology and Circulation.

An ACC/AHA task force and writing group reviewed 11 studies of patients treated with coronary stent implantation that evaluated dual antiplatelet therapy. They also examined a large, randomized controlled trial that compared the use of dual antiplatelet therapy with aspirin monotherapy in patients one to three years after they had an MI.

The members defined dual antiplatelet therapy as aspirin plus a P2Y12 receptor inhibitor such as clopidogrel, prasugrel or ticagrelor.

They recommended a daily dose of 81 mg for patients treated with dual antiplatelet therapy. They also suggested patients with coronary artery disease continue to take aspirin indefinitely once they stop dual antiplatelet therapy.

They found that low-risk patients who received dual antiplatelet therapy for three to six months had no increased risk of stent thrombosis compared with patients who received 12 months of dual antiplatelet therapy. For some patients, the shorter duration treatment period led to less bleeding. In addition, other studies found that patients who received dual antiplatelet therapy for an additional 18 to 36 months had a decrease in MI and stent thrombosis but an increased in bleeding risk.

“Treatment with more intensive antiplatelet therapy and treatment for a longer duration of time with antiplatelet medicines in general involves a fundamental tradeoff between a decreased risk of future heart attack and an increased risk of bleeding complications,” writing committee chair Glenn N. Levine, MD, said in a news release.

The governing bodies of the ACC and the AHA approved the document for publication. The American Association for Thoracic Surgery, American Society of Anesthesiologists, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons endorsed the guidelines.