Abstract | BACKGROUND: 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:
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Authors | Per Olav Vandvik, A Michael Lincoff, Joel M Gore, David D Gutterman, Frank A Sonnenberg, Pablo Alonso-Coello, Elie A Akl, Maarten G Lansberg, Gordon H Guyatt, Frederick A Spencer |
Journal | Chest
(Chest)
Vol. 141
Issue 2 Suppl
Pg. e637S-e668S
(Feb 2012)
ISSN: 1931-3543 [Electronic] United States |
PMID | 22315274
(Publication Type: Journal Article, Practice Guideline)
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Chemical References |
- Fibrinolytic Agents
- Platelet Aggregation Inhibitors
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Topics |
- Aged
- Angioplasty, Balloon, Coronary
- Cardiovascular Diseases
(blood, drug therapy, prevention & control)
- Combined Modality Therapy
- Coronary Disease
(blood, complications, drug therapy)
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Evidence-Based Medicine
- Fibrinolytic Agents
(adverse effects, therapeutic use)
- Humans
- Long-Term Care
- Middle Aged
- Myocardial Ischemia
(blood, complications, drug therapy)
- Platelet Aggregation Inhibitors
(adverse effects, therapeutic use)
- Risk Factors
- Secondary Prevention
- Societies, Medical
- Stents
- Thrombosis
(blood, drug therapy, prevention & control)
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