Critical appraisal of guidelines for coronary artery disease on dual antiplatelet therapy: More consensus than controversies

Zhang, Shaozhao; Zhou, Huimin; Zhuang, Xiaodong; Yang, Dongzi; Sun, Xiaochuan; Zhong, Xiangbin; Lin, Xiaoyu; Hu, Xin; Huang, Yiquan; Liao, Xinxue; Du, Zhimin

doi:10.1002/clc.23275

Cited by 3 publications

(3 citation statements)

References 55 publications

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“…In fact, the CPGs were reviewed by two evaluators, and discrepancies emerged with respect to some items, which persisted even after the second round of discussion and review by external observers. In addition, AGREE II has no standardized method to assess the strength of a recommendation; the authors decided to use previous published methods [ 30 , 32 ]. This procedure can be postulated by other researchers.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist

et al. 2023

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Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as “Recommended”, ranging from 56.3% to 84.3%, the others were described as “Recommended with modification”, ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future.

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Section: Discussionmentioning

confidence: 99%

“…A guideline was “Recommended for use with some modification” if most domains scored between 30% and 60%. “Not recommended for use in practice” implied that most of the domains of the guideline scored approximately 30% or below [ 30 , 31 , 32 ].…”

Section: Methodsmentioning

confidence: 99%

A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist

et al. 2023

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“…1 Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor for up to 6-12 months is a standard treatment following stent implantation, which could prevent ischaemic events and improve prognosis in these patients. 2 However, when patients on DAPT undergo CABG following acute coronary syndrome (ACS) or stent implantation, it will increase the risk of bleeding complications, which is associated with elevated risk of infection and post-operative mortality. 3,4 Current guidelines provide different recommendations on the perioperative management of antiplatelet agents in CABG, which could cause confusion in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of guidelines for dual antiplatelet therapy in coronary artery bypass graft

Zhang

Zhou

et al. 2020

Eur J Clin Investigation

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Background In most situations, many patients undergoing coronary artery bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also required after CABG. The adjustment of antiplatelet strategy remains controversial. In this study, we systematically review current guidelines, seeking consensus and controversies to facilitate clinical practice. Methods and Results Guidelines are searched in PubMed, Embase, ECRI Guidelines Trust and websites of guidelines organizations and professional society. Guidelines with recommendations of DAPT for patients undergo CABG are included. Two reviewers appraised guidelines with the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Relevant recommendations are extracted and summarized. A total of 14 guidelines meeting inclusion criteria are selected, with average AGREE II scores from 44% to 86%. Most guidelines score high in domains other than ‘applicability’. Many guidelines are not detailed enough in reporting considerations behind recommendations. Current guidelines are consistent on the management of antiplatelet strategy before elective CABG and using DAPT after surgery for preventing graft vessel occlusion. Evidence is still lacking in urgent CABG and resumption of the previous DAPT after surgery. Conclusions Current guidelines on DAPT in CABG are generally satisfying. Suspending P2Y12 inhibitors while aspirin continued before elective CABG is recommended, as well as 12 months of DAPT following CABG. More evidence is needed to guide antiplatelet therapy in urgent CABG and to prove the benefits of resuming previous DAPT.

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Weighted gene co-expression network analysis identifies specific modules and hub genes related to coronary artery disease

Zheng

Chen

Guan

et al. 2021

Sci Rep

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This investigation seeks to dissect coronary artery disease molecular target candidates along with its underlying molecular mechanisms. Data on patients with CAD across three separate array data sets, GSE66360, GSE19339 and GSE97320 were extracted. The gene expression profiles were obtained by normalizing and removing the differences between the three data sets, and important modules linked to coronary heart disease were identified using weighted gene co-expression network analysis (WGCNA). Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and genomes (KEGG) pathway enrichment analyses were applied in order to identify statistically significant genetic modules with the Database for Annotation, Visualization and Integrated Discovery (DAVID) online tool (version 6.8; http://david.abcc.ncifcrf.gov). The online STRING tool was used to construct a protein–protein interaction (PPI) network, followed by the use of Molecular Complex Detection (MCODE) plug-ins in Cytoscape software to identify hub genes. Two significant modules (green-yellow and magenta) were identified in the CAD samples. Genes in the magenta module were noted to be involved in inflammatory and immune-related pathways, based on GO and KEGG enrichment analyses. After the MCODE analysis, two different MCODE complexes were identified in the magenta module, and four hub genes (ITGAM, degree = 39; CAMP, degree = 37; TYROBP, degree = 28; ICAM1, degree = 18) were uncovered to be critical players in mediating CAD. Independent verification data as well as our RT-qPCR results were highly consistent with the above finding. ITGAM, CAMP, TYROBP and ICAM1 are potential targets in CAD. The underlying mechanism may be related to the transendothelial migration of leukocytes and the immune response.

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Critical appraisal of guidelines for coronary artery disease on dual antiplatelet therapy: More consensus than controversies

Cited by 3 publications

References 55 publications

A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist

A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist

A systematic review of guidelines for dual antiplatelet therapy in coronary artery bypass graft

Weighted gene co-expression network analysis identifies specific modules and hub genes related to coronary artery disease

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