Focused 2012 update of the Canadian Cardiovascular Society guidelines for the use of antiplatelet therapy

Can J Cardiol. 2013 Nov;29(11):1334-45. doi: 10.1016/j.cjca.2013.07.001. Epub 2013 Aug 23.


The initial 2010 Canadian Cardiovascular Society (CCS) Guidelines for the Use of Antiplatelet Therapy in the Outpatient Setting were published in May 2011. As part of a planned re-evaluation within 2 years, we conducted an extensive literature search encompassing all topics included in the 2010 CCS Guidelines, and concluded that there were sufficient new data to merit revisiting the guidance on antiplatelet therapy for secondary prevention in the first year after acute coronary syndrome (ACS), percutaneous coronary intervention, or coronary artery bypass grafting, and the interaction between clopidogrel and proton pump inhibitors. In addition, new clinical trials information about the efficacy and safety of combining novel oral anticoagulants with antiplatelet therapy in ACS justified the addition of a new section of recommendations to the Guidelines. In this focused update, we provide recommendations for the use of clopidogrel, ticagrelor, and prasugrel in non-ST elevation ACS, avoidance of prasugrel in patients with previous stroke/transient ischemic attack, higher doses of clopidogrel (j) /day) for the first 6 days after ACS, and the preferential use of prasugrel or ticagrelor after percutaneous coronary intervention in ACS. For non-ACS stented patients, we recommend acetylsalicylic acid/clopidogrel for 1 year, with at least 1 month of therapy for bare-metal stent patients and 3 months for drug-eluting stent patients unable to tolerate year-long double therapy. We also consider therapy for patients with a history of stent thrombosis, the indications for longer-term treatment, discontinuation timing preoperatively, indications for changing agents, the management of antiplatelet therapy before and after bypass surgery, and use/selection of proton pump inhibitors along with antiplatelet agents.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Coronary Syndrome / therapy*
  • Adenosine / administration & dosage
  • Adenosine / adverse effects
  • Adenosine / analogs & derivatives
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Aspirin / administration & dosage
  • Aspirin / adverse effects
  • Clinical Trials as Topic
  • Clopidogrel
  • Contraindications
  • Coronary Artery Bypass*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Interactions
  • Drug Therapy, Combination
  • Hemorrhage / chemically induced
  • Hemorrhage / prevention & control
  • Humans
  • Myocardial Infarction / prevention & control
  • Percutaneous Coronary Intervention*
  • Piperazines / administration & dosage
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Aggregation Inhibitors / adverse effects
  • Prasugrel Hydrochloride
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / adverse effects
  • Secondary Prevention
  • Stents
  • Stroke / prevention & control
  • Thiophenes / administration & dosage
  • Thrombosis / prevention & control
  • Ticagrelor
  • Ticlopidine / administration & dosage
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives


  • Anticoagulants
  • Piperazines
  • Platelet Aggregation Inhibitors
  • Proton Pump Inhibitors
  • Thiophenes
  • Clopidogrel
  • Prasugrel Hydrochloride
  • Ticagrelor
  • Adenosine
  • Ticlopidine
  • Aspirin