2023 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

Antiplatelet therapy (APT) is the foundation of treatment and prevention of atherothrombotic events in atherosclerotic cardiovascular disease (ASCVD). Selecting the optimal APT strategies to reduce major adverse cardiovascular events (MACE), while balancing bleeding risk, requires ongoing review of clinical trials. Appended, the focused update of the Canadian Cardiovascular Society (CCS)/Canadian Association of Interventional Cardiology (CAIC) guidelines for the use of APT provides recommendations on the following topics: 1) use of acetylsalicylic acid (ASA) in primary prevention of ASCVD; 2) dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR); 3) Potent DAPT (P2Y12 inhibitor) choice in patients presenting with an acute coronary syndrome (ACS) and possible DAPT de-escalation strategies following PCI; 4) choice and duration of DAPT in ACS patients who are medically treated without revascularization; 5) pre-treatment with DAPT (P2Y12 inhibitor) before elective or non-elective coronary angiography; 6) peri-operative and longer-term APT management in patients requiring coronary artery bypass graft (CABG) surgery; 7) use of APT in atrial fibrillation requiring oral anticoagulation (OAC) after PCI or medically managed ACS. These recommendations are all based on systematic reviews and meta-analyses conducted as part of the development of these guidelines, provided in the online supplementary material.Use of ASA in primary prevention of ASCVD