Antiplatelet Therapy in Atherothrombotic Diseases: Similarities and Differences Across Guidelines

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  FIGURE 1. Main differences in antiplatelet therapy recommendations in ACS patients across guidelines. § in case of history of prior bleeding, oral anticoagulant therapy, female sex, advanced age, low body weight, chronic kidney disease, diabetes mellitus, anemia, chronic steroid or nonsteroidal anti-inflammatory drugs (NSAID) therapy (American guidelines); having PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score ≥25 or meeting the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria (European guidelines); having PRECISE-DAPT score ≥25 or DAPT score <2 (given as examples since limited data are available to evaluate the applicability of these scoring systems to the Japanese population; Japanese guidelines). * having at least one clinical (prior myocardial infarction, troponin-positive acute coronary syndrome, diabetes mellitus treated with oral hypoglycemics or insulin, chronic kidney disease with creatinine clearance <60 ml/min, previous stent thrombosis or current smoker) or angiographic features (multiple stents (≥3 stents implanted, ≥3 lesions stented), use of a biodegradable…

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  FIGURE 2. Antiplatelet therapy in ACS patients undergoing PCI. § in case of history of prior bleeding, oral anticoagulant therapy, female sex, advanced age, low body weight, chronic kidney disease, diabetes mellitus, anemia, chronic steroid or nonsteroidal anti-inflammatory drugs (NSAID) therapy (American guidelines); in case of need for oral anticoagulant drugs in addition to DAPT, advanced age (older than 75 years), frailty, anemia with hemoglobin <110 g/L, chronic renal failure (creatinine clearance <40 ml/min), low body weight (<60 kg), hospitalization for bleeding within past year, previous stroke/intracranial bleed or regular need for NSAIDs or prednisone (Canadian guidelines); having PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score ≥25 or meeting the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria (European guidelines); having PRECISE-DAPT score ≥25 or DAPT score <2 (given as examples since limited data are available to evaluate the applicability of these scoring systems to the Japanese population; Japanese guidelines). * except for the Canadian guidelines that do not…

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  FIGURE 3. Antithrombotic therapy in nonvalvular AF patients undergoing PCI. * default strategy recommended by the American guidelines irrespective of the bleeding/ischemic risk stratification. § advanced age (older than 75 years), frailty, anemia with hemoglobin <110 g/L, chronic renal failure (creatinine clearance <40 ml/min), low body weight (<60 kg), hospitalization for bleeding within past year, previous stroke/intracranial bleed or regular need for NSAIDs or prednisone (Canadian guidelines); having Hypertension, Abnormal renal and liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly (>65 years), Drugs and alcohol (HAS-BLED) score ≥3 or Age, Biomarkers (growth differentiation factor-15 (GDF-15), high-sensitivity cardiac troponin T (cTnT-hs) and haemoglobin), and Clinical history (previous bleeding) (ABC) score >2 (European guidelines); having PRECISE-DAPT score ≥25 or DAPT score <2 (given as examples since limited data are available to evaluate the applicability of these scoring systems to the Japanese population; Japanese guidelines). † having at least one clinical (before myocardial infarction, troponin-positive acute coronary syndrome, diabetes mellitus…

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  FIGURE 4. Antiplatelet therapy in CAD patients undergoing PCI. § in case of history of prior bleeding, oral anticoagulant therapy, female sex, advanced age, low body weight, chronic kidney disease, diabetes mellitus, anemia, chronic steroid or nonsteroidal anti-inflammatory drugs (NSAID) therapy (American guidelines); in case of need for oral anticoagulant drugs in addition to DAPT, advanced age (older than 75 years), frailty, anemia with hemoglobin <110 g/L, chronic renal failure (creatinine clearance <40 ml/min), low body weight (<60 kg), hospitalization for bleeding within past year, previous stroke/intracranial bleed or regular need for NSAIDs or prednisone (Canadian guidelines); having PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score ≥25 (European guidelines); having PRECISE-DAPT score ≥25 or DAPT score <2 (given as examples since limited data are available to evaluate the applicability of these scoring systems to the Japanese population; Japanese guidelines). * Japanese guidelines recommend either clopidogrel or prasugrel. # ESC recommends shortening the duration of DAPT down to 1 month if…