CCS 2023 Antiplatelet Guidelines!

Thank you Dr. Jung-In Choi (PGY4 in Cardiology) for a fantastic and evidence-filled run through the CCS 2023 Focused Update of the Guidelines for the Use of Antiplatelet Therapy.

See her didactic slide deck here.

Key takeaway points:

Primary prevention ASA:
- CCS recommends against routine use of ASA for primary prevention of ASCVD
- Patients already on ASA or patients who have subclinical ASCVD require patient-centered informed shared decision making
DAPT post PCI
- Elective PCI: recommend 6 months ASA + clopidogrel followed by SAPT
- ACS: recommend 12 months (ASA + high potency P2Y12i i.e. ticagrelor or prasugrel) followed by SAPT
- High risk bleeding: 1-3 months DAPT then step down to SAPT or step down from ASA + high potency P2Y12i to ASA + clopidogrel
  - Major criteria (only need 1) for high risk bleeding includes: eGFR < 30, cirrhosis with portal hypertension, active malignancy within last 12 months, chronic hemoglobin < 110, chronic platelets < 100, etc.
- High ischemic/ thrombotic risk: extend DAPT up to 3 years.
- Risk scores validated for DAPT duration: PRECISE-DAPT score or DAPT score
DAPT in medically managed ACS
- Insufficient data to provide specific recommendation on duration of DAPT
Pre-treatment with DAPT before PCI
- Stable ischemic heart disease: pretreatment with DAPT not recommended
- NSTEMI: if coronary angiogram anticipated within 24h, pretreatment with DAPT is not recommended
- STEMI: pretreatment with DAPT is recommended