2020 Asian Pacific Society of Cardiology Consensus Recommendations on Antithrombotic Management for High-risk Chronic Coronary Syndrome

Abstract

The unique characteristics of patients with chronic coronary syndrome (CCS) in the Asia-Pacific region, heterogeneous approaches because of differences in accesses and resources and low number of patients from the Asia-Pacific region in pivotal studies, mean that international guidelines cannot be routinely applied to these populations. The Asian Pacific Society of Cardiology developed these consensus recommendations to summarise current evidence on the management of CCS and provide recommendations to assist clinicians treat patients from the region. The consensus recommendations were developed by an expert consensus panel who reviewed and appraised the available literature, with focus on data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting recommendations provide guidance on the assessment and management of bleeding and ischaemic risks in Asian CCS patients. Furthermore, the selection of long-term antithrombotic therapy is discussed, including the role of single antiplatelet therapy, dual antiplatelet therapy and dual pathway inhibition therapy.

Asian Pacific Society of Cardiology Consensus Recommendations on Dyslipidaemia

“…For the development of these consensus recommendations, the panel agreed to use the APSC ‘CVD’ system for defining high-risk and very-high-risk patients ( Table 1 ). [ 2 ]…”

“…Recommendation 1. Patients with chronic coronary syndrome (CCS) should be assessed according to the Coronary–Vascular–Disease (‘CVD’) system (APSC CCS consensus recommendations[ 2 ]) and categorised as having high-risk CCS (one risk factor) or very-high-risk CCS (more than one risk factor).…”

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“…In the aforementioned APSC consensus statement on the management of high-risk CCS, the APSC recommended various antithrombotic management strategies based on the patient’s ischaemic and bleeding risk. [ 32 ] However, since its development, several studies and guidelines have been published, which warranted a review of the treatment of patients with CCS, particularly those transitioning from ACS to CCS.…”

“…Given this data gap, the expert panel referred to the 2019 APSC consensus statements on high-risk CCS, which suggest the use of SAPT in such patients where excessive bleeding risk has been identified. [ 32 ] Therapy for frail patients must be individualised and must consider other factors such as life expectancy, quality of life, and patient preferences. [ 70 ]…”

“…[ 26 ] We subsequently produced a consensus paper on the management of high-risk CCS, where we proposed two sets of criteria: the Coronary–Vascular–Disease criteria, distinguishing high-risk from very-high risk CCS ( Table 1 ); and the Age–Bleeding–Organ failure (ABO) criteria, describing bleeding risk among Asian patients with CCS ( Figure 1 ). [ 32 ]…”