Coronary heart disease secondary prevention antiplatelet agents/anticoagulants

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]

Antiplatelet Agents and Anticoagulants (DO NOT EDIT) [1]

Class I

"1. Aspirin 75–162 mg daily is recommended in all patients with coronary artery disease unless contraindicated. [2][3][4][5] (Level of Evidence: A)

  • Clopidogrel 75 mg daily is recommended as an alternative for patients who are intolerant of or allergic to aspirin. [6] (Level of Evidence: B)"

"2. A P2Y12 receptor antagonist in combination with aspirin is indicated in patients after ACS or PCI with stent placement. [7][8][9] (Level of Evidence: A)

"3. For patients undergoing coronary artery bypass grafting, aspirin should be started within 6 hours after surgery to reduce saphenous vein graft closure. Dosing regimens ranging from 100 to 325 mg daily for 1 year appear to be efficacious. [13][14][15][16] (Level of Evidence: A)"

"4. In patients with extracranial carotid or vertebral atherosclerosis who have had ischemic stroke or TIA, treatment with aspirin alone (75–325 mg daily), clopidogrel alone (75 mg daily), or the combination of aspirin plus extended-release dipyridamole (25 mg and 200 mg twice daily, respectively) should be started and continued. [17][5] (Level of Evidence: B)"

"5. For patients with symptomatic atherosclerotic peripheral artery disease of the lower extremity, antiplatelet therapy with aspirin (75–325 mg daily) or clopidogrel (75 mg daily) should be started and continued. [18][19][5][6] (Level of Evidence: A)"

"6. Antiplatelet therapy is recommended in preference to anticoagulant therapy with warfarin or other vitamin K antagonists to treat patients with atherosclerosis. [20][21][22][23] (Level of Evidence: A)

Class IIa

"1. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by thienopyridine therapy after stent implantation, earlier discontinuation (eg, <12 months) is reasonable. (Level of Evidence: C) (Note: the risk for serious cardiovascular events because of early discontinuation of thienopyridines is greater for patients with drug-eluting stents than those with bare-metal stents.)"

"2. After PCI, it is reasonable to use 81 mg of aspirin per day in preference to higher maintenance doses. [8][9][32][33][34][35][36] (Level of Evidence: B)"

"3. For patients undergoing coronary artery bypass grafting, clopidogrel (75 mg daily) is a reasonable alternative in patients who are intolerant of or allergic to aspirin. (Level of Evidence: C)"

Class IIb

"1. The benefits of aspirin in patients with asymptomatic peripheral artery disease of the lower extremities are not well established. [37][38] (Level of Evidence: B)"

"2. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. [39] (Level of Evidence: B)"

References

  1. ↑ 1.0 1.1 Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.
  2. ↑ Gibbons RJ, Abrams J, Chatterjee K; et al. (2003). "ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)". Circulation. 107 (1): 149–58. PMID 12515758. Unknown parameter |month= ignored (help)
  3. ↑ Vandvik PO, Lincoff AM, Gore JM; et al. (2012). "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". Chest. 141 (2 Suppl): e637S–68S. doi:10.1378/chest.11-2306. PMID 22315274. Unknown parameter |month= ignored (help)
  4. ↑ Baigent C, Blackwell L, Collins R; et al. (2009). "Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials". Lancet. 373 (9678): 1849–60. doi:10.1016/S0140-6736(09)60503-1. PMC 2715005. PMID 19482214. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 5.2 "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients". BMJ. 324 (7329): 71–86. 2002. PMC 64503. PMID 11786451. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee". Lancet. 348 (9038): 1329–39. 1996. PMID 8918275. Unknown parameter |month= ignored (help)
  7. ↑ Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001). "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation". N. Engl. J. Med. 345 (7): 494–502. doi:10.1056/NEJMoa010746. PMID 11519503. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 8.2 Mehta SR, Yusuf S, Peters RJ; et al. (2001). "Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study". Lancet. 358 (9281): 527–33. PMID 11520521. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Steinhubl SR, Berger PB, Mann JT; et al. (2002). "Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial". JAMA. 288 (19): 2411–20. PMID 12435254. Unknown parameter |month= ignored (help)
  10. ↑ Montalescot G, Wiviott SD, Braunwald E; et al. (2009). "Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial". Lancet. 373 (9665): 723–31. doi:10.1016/S0140-6736(09)60441-4. PMID 19249633. Unknown parameter |month= ignored (help)
  11. ↑ Wiviott SD, Braunwald E, McCabe CH; et al. (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". N. Engl. J. Med. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182. Unknown parameter |month= ignored (help)
  12. ↑ Wallentin L, Becker RC, Budaj A; et al. (2009). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes". N. Engl. J. Med. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Unknown parameter |month= ignored (help)
  13. ↑ Chesebro JH, Fuster V, Elveback LR; et al. (1984). "Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations". N. Engl. J. Med. 310 (4): 209–14. doi:10.1056/NEJM198401263100401. PMID 6361561. Unknown parameter |month= ignored (help)
  14. ↑ Lorenz RL, Schacky CV, Weber M; et al. (1984). "Improved aortocoronary bypass patency by low-dose aspirin (100 mg daily). Effects on platelet aggregation and thromboxane formation". Lancet. 1 (8389): 1261–4. PMID 6144975. Unknown parameter |month= ignored (help)
  15. ↑ Sharma GV, Khuri SF, Josa M, Folland ED, Parisi AF (1983). "The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency". Circulation. 68 (3 Pt 2): II218–21. PMID 6347428. Unknown parameter |month= ignored (help)
  16. ↑ Mangano DT (2002). "Aspirin and mortality from coronary bypass surgery". N. Engl. J. Med. 347 (17): 1309–17. doi:10.1056/NEJMoa020798. PMID 12397188. Unknown parameter |month= ignored (help)
  17. ↑ Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A (2006). "Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial". Lancet. 367 (9523): 1665–73. doi:10.1016/S0140-6736(06)68734-5. PMID 16714187. Unknown parameter |month= ignored (help)
  18. ↑ Catalano M, Born G, Peto R (2007). "Prevention of serious vascular events by aspirin amongst patients with peripheral arterial disease: randomized, double-blind trial". J. Intern. Med. 261 (3): 276–84. doi:10.1111/j.1365-2796.2006.01763.x. PMID 17305650. Unknown parameter |month= ignored (help)
  19. ↑ Hirsch AT, Haskal ZJ, Hertzer NR; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Unknown parameter |month= ignored (help)
  20. ↑ Anand SS, Yusuf S (1999). "Oral anticoagulant therapy in patients with coronary artery disease: a meta-analysis". JAMA. 282 (21): 2058–67. PMID 10591389. Unknown parameter |month= ignored (help)
  21. ↑ Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H (2002). "Warfarin, aspirin, or both after myocardial infarction". N. Engl. J. Med. 347 (13): 969–74. doi:10.1056/NEJMoa020496. PMID 12324552. Unknown parameter |month= ignored (help)
  22. ↑ Mohr JP, Thompson JL, Lazar RM; et al. (2001). "A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke". N. Engl. J. Med. 345 (20): 1444–51. doi:10.1056/NEJMoa011258. PMID 11794192. Unknown parameter |month= ignored (help)
  23. ↑ 23.0 23.1 23.2 Anand S, Yusuf S, Xie C; et al. (2007). "Oral anticoagulant and antiplatelet therapy and peripheral arterial disease". N. Engl. J. Med. 357 (3): 217–27. doi:10.1056/NEJMoa065959. PMID 17634457. Unknown parameter |month= ignored (help)
  24. ↑ "Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials". Arch. Intern. Med. 154 (13): 1449–57. 1994. PMID 8018000. Unknown parameter |month= ignored (help)
  25. ↑ Turpie AG, Gent M, Laupacis A; et al. (1993). "A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement". N. Engl. J. Med. 329 (8): 524–9. doi:10.1056/NEJM199308193290802. PMID 8336751. Unknown parameter |month= ignored (help)
  26. ↑ Mok CK, Boey J, Wang R; et al. (1985). "Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial". Circulation. 72 (5): 1059–63. PMID 3899404. Unknown parameter |month= ignored (help)
  27. ↑ "Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial". Lancet. 348 (9028): 633–8. 1996. PMID 8782752. Unknown parameter |month= ignored (help)
  28. ↑ Kearon C, Gent M, Hirsh J; et al. (1999). "A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism". N. Engl. J. Med. 340 (12): 901–7. doi:10.1056/NEJM199903253401201. PMID 10089183. Unknown parameter |month= ignored (help)
  29. ↑ Becker RC, Meade TW, Berger PB; et al. (2008). "The primary and secondary prevention of coronary artery disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 776S–814S. doi:10.1378/chest.08-0685. PMID 18574278. Unknown parameter |month= ignored (help)
  30. ↑ Bonow RO, Carabello BA, Kanu C; et al. (2006). "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". Circulation. 114 (5): e84–231. doi:10.1161/CIRCULATIONAHA.106.176857. PMID 16880336. Unknown parameter |month= ignored (help)
  31. ↑ Fiore LD, Ezekowitz MD, Brophy MT, Lu D, Sacco J, Peduzzi P (2002). "Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study". Circulation. 105 (5): 557–63. PMID 11827919. Unknown parameter |month= ignored (help)
  32. ↑ Chen ZM, Jiang LX, Chen YP; et al. (2005). "Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial". Lancet. 366 (9497): 1607–21. doi:10.1016/S0140-6736(05)67660-X. PMID 16271642. Unknown parameter |month= ignored (help)
  33. ↑ Brar SS, Kim J, Brar SK; et al. (2008). "Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions". J. Am. Coll. Cardiol. 51 (23): 2220–7. doi:10.1016/j.jacc.2008.01.063. PMID 18534267. Unknown parameter |month= ignored (help)
  34. ↑ Patrono C, Baigent C, Hirsh J, Roth G (2008). "Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 199S–233S. doi:10.1378/chest.08-0672. PMID 18574266. Unknown parameter |month= ignored (help)
  35. ↑ Steinhubl SR, Bhatt DL, Brennan DM; et al. (2009). "Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding". Ann. Intern. Med. 150 (6): 379–86. PMID 19293071. Unknown parameter |month= ignored (help)
  36. ↑ Serebruany VL, Steinhubl SR, Berger PB; et al. (2005). "Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials". Am. J. Cardiol. 95 (10): 1218–22. doi:10.1016/j.amjcard.2005.01.049. PMID 15877994. Unknown parameter |month= ignored (help)
  37. ↑ Berger JS, Krantz MJ, Kittelson JM, Hiatt WR (2009). "Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials". JAMA. 301 (18): 1909–19. doi:10.1001/jama.2009.623. PMID 19436018. Unknown parameter |month= ignored (help)
  38. ↑ Fowkes FG, Price JF, Stewart MC; et al. (2010). "Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial". JAMA. 303 (9): 841–8. doi:10.1001/jama.2010.221. PMID 20197530. Unknown parameter |month= ignored (help)
  39. ↑ Bhatt DL, Flather MD, Hacke W; et al. (2007). "Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial". J. Am. Coll. Cardiol. 49 (19): 1982–8. doi:10.1016/j.jacc.2007.03.025. PMID 17498584. Unknown parameter |month= ignored (help)


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