Pautas de optimización del tratamiento antiagregante tras un infarto agudo de miocardio

Abstract

Cardiovascular diseases are the leading cause of death in developed countries and account for more than a third of their healthcare costs. Acute coronary syndrome (ACS) is frequently one of the first manifestations of cardiovascular disease. There are important differences in post-ACS clinical management between centres and autonomous communities in Spain, as well as the clinical criteria used for applying the continuation of dual antiplatelet treatment (DAPT). Although there is an elevated number of potential candidates for prolonging DAPT beyond 1 year, recent data suggest that it is only applied in around one third of patients. Therefore, homogenizing treatment and follow-up criteria could contribute to reducing hospital stay and in-hospital mortality associated with ACS. To help this purpose, we propose a protocol of patient care management with practical applicability in our centres. This document also has the objective of synthesizing the recommendations of the clinical practice guidelines on post-ACS risk stratification and optimization of DAPT, proposing an algorithm to guide decision making. In line with the latest European clinical practice guidelines on ACS, we advise considering DAPT prolongation in patients who tolerated the treatment during the first year and have a significant residual thrombotic risk (moderate or high) without high bleeding risk. To assess bleeding risk, we recommend using the ARC-HBR scale, while the PRECISE-DAPT and DAPT scales can be used to integrate ischemic and haemorrhagic risk at discharge and 1 year after ACS, respectively.