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

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Clinical Guidelines
Authored By
Zhang S, Zhou H, Zhuang X, Yang D, Sun X, Zhong X, Lin X, Hu X, Huang Y, Liao X, Du Z
Authored On
Interests
Cardiology
Emergency Medicine
Speciality
Cardiology
Emergency Medicine
Book Detail
volume
42
ISSN
1932-8737
No. of pages
11
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ISSN
1932-8737 ; Electronic
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true
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Additional Info
["Zhang S, Zhou H, Zhuang X, Yang D, Sun X, Zhong X, Lin X, Hu X, Huang Y, Liao X, Du Z","Publisher: John Wiley & Sons, Inc Country of Publication: United States NLM ID: 7903272 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1932-8737 (Electronic) Linking ISSN: 01609289 NLM ISO Abbreviation: Clin Cardiol Subsets: MEDLINE","Journal Article; Review","2019-12-01","Clinical cardiology [Clin Cardiol] 2019 Dec; Vol. 42 (12), pp. 1170-1180. Date of Electronic Publication: 2019 Oct 14.","English","1932-8737","Dual Anti-Platelet Therapy*, Coronary Artery Disease\/*drug therapy , Platelet Aggregation Inhibitors\/*therapeutic use, Humans ; Practice Guidelines as Topic","Humans, Practice Guidelines as Topic, Coronary Artery Disease drug therapy, Dual Anti-Platelet Therapy, Platelet Aggregation Inhibitors therapeutic use","Clinical cardiology","42"]
Description
Background: Dual antiplatelet therapy (DAPT) in the form of aspirin plus a P <subscript>2</subscript> Y <subscript>12</subscript> inhibitor, when indicated, is one of the key treatments in coronary artery disease (CAD). Many recommendations on DAPT in patients with CAD based on current guidelines are largely inconsistent. In our current study, we aimed at systematically reviewing DAPT-relevant clinical practice guidelines, and highlighting their commonalities and differences for better informed decision-making.<br />Methods: Contemporary guidelines in English were searched in MEDLINE, Embase and websites of guideline organizations and professional societies. Guidelines with recommendations on DAPT for CAD patients were included. Guideline quality was appraised with the 6-domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The reporting of conflicts of interest (COI) was assessed individually with supplementary items from the RIGHT (Reporting Item for Practice Guidelines in Healthcare) checklist. Meanwhile, extraction of recommendations was performed.<br />Results: A total of 18 guidelines fulfilled our inclusion criteria. Most of them were graded with relatively good scores averaging from 42% to 74%. Domains for lower scores were in "stakeholder involvement" and "application." The reporting of COI was satisfactory. For the recommendations on DAPT, most guidelines with high AGREE II scores included consistent recommendations on the timing and P <subscript>2</subscript> Y <subscript>12</subscript> inhibitor selection. Nonetheless, conflicts still exist on the duration of DAPT.<br />Conclusions: Quality of guidelines for DAPT in CAD was relatively high, though defects existed in "Applicability" and "Stakeholder Involvement." As these guidelines developed, DAPT recommendations gradually converged on a consensus. Clinical decision should be made on an individual basis.<br /> (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)
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