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Review
. 2022 Feb 14;194(6):E205-E215.
doi: 10.1503/cmaj.202863.

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

Mohammad Alkhalil  1 , Michał Kuzemczak  2 , Alan Bell  2 , Sol Stern  2 , Michelle Welsford  2 , Warren J Cantor  2 , Shaun G Goodman  2
Affiliations
Review

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

Mohammad Alkhalil et al. CMAJ. .
No abstract available

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Conflict of interest statement

Competing interests: Alan Bell reports consulting fees from AstraZeneca, Bayer and Sanofi; speaker fees from AstraZeneca; and board membership with Thrombosis Canada, Hypertension Canada and the Canadian Cardiovascular Society. Sol Stern reports honoraria from Bayer, Pfizer, Bristol Myers Squibb and Sea Courses Inc. Shaun Goodman reports research grant support from Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Eli Lilly, Esperion, Ferring Pharmaceuticals, Merck, Novartis, Pfizer, Regeneron, Sanofi, Heart and Stroke Foundation of Ontario, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Center for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Center, PERFUSE Research Institute and TIMI Study Group (Brigham Health). He also reports consulting honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Eli Lilly, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, PendoPharm of Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharma, Canadian Heart Research Centre and MD Primer, and speaking fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Novartis, PendoPharm of Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharm, Canadian Heart Research Centre and MD Primer. He sits on boards with American Regent of Daiichi-Sankyo and Novo Nordisk and is co-director of the Canadian VIGOUR Centre. All competing interests are outside the submitted work. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Antiplatelet recommendations in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Note: ASA = acetylsalicylic acid, BID = twice daily, DAPT = dual antiplatelet therapy, NSTACS = non-ST segment elevation acute coronary syndrome, OD = once daily, SAPT = single antiplatelet therapy, STEMI = ST-segment elevation myocardial infarction.
Figure 2:
Figure 2:
Antiplatelet management in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF). Direct oral anticoagulation (DOAC) is preferred over warfarin; however, if warfarin is to be used the recommended international normalized ratio target is 2.0–2.5. The timing of when to discontinue acetylsalicyclic acid (ASA) will depend on the individual patient’s ischemic and bleeding risk. Note: PCI = percutaneous coronary intervention.
Figure 3:
Figure 3:
Flowchart for antiplatelet management in patients with acute coronary syndrome. Note: ASA = acetylsalicylic acid, CABG = coronary artery bypass grafting, OAC = oral anticoagulant, PCI = percutaneous coronary intervention. *Patients receiving fibrinolytic therapy should be loaded with ASA and clopidogrel. Switching to ticagrelor within 24 hours should be considered.
See this image and copyright information in PMC

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