CHEST Guidelines-Primary-and-Secondary-Prevention-of-Cardiovascular

Primary-and-Secondary-Prevention-of-Cardiovascular

Pdf Summary

The 9th Edition of the American College of Chest Physicians (ACCP) Guidelines offers recommendations for antithrombotic therapy and the prevention of thrombosis, focusing on both primary and secondary cardiovascular disease prevention. <br /><br />For primary prevention, low-dose aspirin (75-100 mg/day) is recommended for individuals aged 50 and above who do not yet manifest symptoms of cardiovascular disease, though it must be balanced against the increased risk of gastrointestinal bleeding. <br /><br />In patients with established coronary artery disease (CAD), long-term administration of low-dose aspirin or clopidogrel (75 mg/day) is advocated to reduce the risk of recurrent cardiovascular events. For individuals who undergo percutaneous coronary interventions (PCI) with stent placement, a combination of dual antiplatelet therapy (DAPT) with aspirin and either ticagrelor or clopidogrel is recommended for up to a year, to be followed by single antiplatelet therapy.<br /><br />For those with acute coronary syndromes, DAPT is advised over single therapy for the first year. Patients who experience a large anterior myocardial infarction (MI) with left ventricular thrombus formation or heightened risk should be prescribed warfarin in conjunction with aspirin for the first three months, regardless of stenting procedures, to mitigate embolic risk.<br /><br />For patients receiving stents during elective PCI, short-term DAPT with aspirin and clopidogrel is recommended, especially for bare-metal stents, for up to a month. With drug-eluting stents, the duration of DAPT may extend to six months or longer. <br /><br />The report cautions against the use of dual antiplatelet therapy beyond 12 months post-DES placement, citing no substantial benefit and potential risk. <br /><br />In patients with systolic left ventricular dysfunction without CAD, neither antiplatelet therapy nor warfarin is commonly advocated unless acute thrombosis is identified.<br /><br />Overall, these guidelines underscore personalized treatment regimes based on individual risk profiles, with a key focus on minimizing bleeding risks while safeguarding against thrombotic events.

Keywords

ACCP Guidelines

antithrombotic therapy

cardiovascular disease prevention

low-dose aspirin

dual antiplatelet therapy

coronary artery disease

percutaneous coronary interventions

myocardial infarction

warfarin

personalized treatment