Although acetylsalicylic acid (ASA) is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular (CV) events, residual atherothrombotic risk has prompted guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary “snapshot” of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada.
Canadian cardiologists (49 cardiologists from 6 provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy (COMPASS)-like criteria from May 18 to April 2019.
Of the 492 (two cardiologists provided 11 patients) enrolled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularization was common (PCI 61%, CABG 39%) with 31% having multivessel disease. A total of 47% of patients had a REACH bleeding score of ≥11 (~2.8% risk of serious bleeding at 2-years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC) with 16% being on NOAC alone, 5% on DPI and 1% received triple therapy.
In contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk.

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