The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines Executive Summary
The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines Executive Summary
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DOI：
10.1016/j.cjca.2010.12.033
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发表时间：
2011-03-01
影响因子：
6.2
通讯作者：
Tanguay, Jean-Francois
中科院分区：
文献类型：
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作者：
Bell, Alan D.;Roussin, Andre;Tanguay, Jean-Francois
抗血小板药物是动脉粥样硬化性血管疾病患者治疗的基石。目前缺乏一个全面的指导方针，重点是使用抗血小板药物的患者目前表现出或在心血管疾病的风险增加。加拿大抗血小板治疗指南委员会审查了现有的基于疾病的指南和随后发表的文献，并使用专家意见和审查来制定门诊抗血小板治疗指南。本执行摘要简要介绍了主要建议。抗血小板治疗似乎普遍使用不足，部分原因可能是缺乏明确的循证指南。在此，我们为急性冠状动脉综合征、经皮冠状动脉介入治疗或冠状动脉旁路移植术后出院的患者、有短暂性脑缺血事件或卒中病史的患者以及外周动脉疾病患者提供了二级预防的具体指南。与初级预防有关的问题也得到了解决，除了特殊的临床情况，如糖尿病，心力衰竭，慢性肾病，怀孕或哺乳，围手术期管理。提供了关于华法林、氯吡格雷和质子泵抑制剂或阿司匹林和非甾体抗炎药联合治疗期间可能发生的药理学相互作用以及出血并发症管理的建议。完整的指南文件作为《加拿大心脏病学杂志》的增刊出版，可在http://www.ccs.ca/上查阅。
Antiplatelet agents are a cornerstone of therapy for patients with atherosclerotic vascular disease. There is presently a lack of comprehensive guidelines focusing on the use of antiplatelet drugs in patients currently manifesting or at elevated risk of cardiovascular disease. The Canadian Antiplatelet Therapy Guidelines Committee reviewed existing disease-based guidelines and subsequently published literature and used expert opinion and review to develop guidelines on the use of antiplatelet therapy in the outpatient setting. This Executive Summary provides an abbreviated version of the principal recommendations. Antiplatelet therapy appears to be generally underused, perhaps in part because of a lack of clear, evidence-based guidance. Here, we provide specific guidelines for secondary prevention in patients discharged from hospital after acute coronary syndromes, percutaneous coronary intervention, or coronary artery bypass grafting; patients with a history of transient cerebral ischemic events or strokes; and patients with peripheral arterial disease. Issues related to primary prevention are also addressed, in addition to special clinical contexts such as diabetes, heart failure, chronic kidney disease, pregnancy or lactation, and perioperative management. Recommendations are provided regarding pharmacologic interactions that may occur during combination therapy with warfarin, clopidogrel, and proton-pump inhibitors, or aspirin and nonsteroidal anti-inflammatory drugs, as well as for the management of bleeding complications. The complete guidelines document is published as a supplementary issue of the Canadian Journal of Cardiology and is available at http://www.ccs.ca/.