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Can J Cardiol. 2018 Mar;34(3):214-233. doi: 10.1016/j.cjca.2017.12.012. Epub 2017 Dec 19.

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy.

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McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address:
University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
University of Toronto and Southlake Regional Health Centre, Toronto, Ontario, Canada.
Université de Montréal and Institut de Cardiologie de Montréal, Montréal, Quebec, Canada.
Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
University of Toronto, Toronto, Ontario, Canada.
McMaster University and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
University of Toronto and Women's College Hospital and Peter Munk Cardiac Centre of Toronto General Hospital, Toronto, Ontario, Canada.
University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada.
Université de Montréal and Institut de Cardiologie de Montréal, Montréal, Quebec, Canada. Electronic address:


Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence. The present update to the 2011 and 2013 Canadian Cardiovascular Society APT guidelines incorporates new evidence on how to optimize APT use, particularly in situations in which few to no data were previously available. The recommendations update focuses on the following primary topics: (1) the duration of dual APT (DAPT) in patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome and non-acute coronary syndrome indications; (2) management of DAPT in patients who undergo noncardiac surgery; (3) management of DAPT in patients who undergo elective and semiurgent coronary artery bypass graft surgery; (4) when and how to switch between different oral antiplatelet therapies; and (5) management of antiplatelet and anticoagulant therapy in patients who undergo PCI. For PCI patients, we specifically analyze the particular considerations in patients with atrial fibrillation, mechanical or bioprosthetic valves (including transcatheter aortic valve replacement), venous thromboembolic disease, and established left ventricular thrombus or possible left ventricular thrombus with reduced ejection fraction after ST-segment elevation myocardial infarction. In addition to specific recommendations, we provide values and preferences and practical tips to aid the practicing clinician in the day to day use of these important agents.

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