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Clinical Advances in

ACS Management in the Modern Era

The greatest value in the prevention of cardiovascular disease (CVD) is achieved from the application of therapies to prevent subsequent events and progression of disease in patients with established CVD. This collection focuses on identifying the ideal antiplatelet regimen at the dose, duration, and for the appropriate clinical indication to achieve the optimal balance of potency and safety. The collection importantly incorporates system-, provider-, and patient-directed strategies to improve adherence to contemporary evidence-based guidelines.

Supported by an independent educational grant from



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Polling Question

Which antiplatelet therapy would you recommend at discharge following coronary artery bypass surgery for an ACS?
Aspirin alone
Aspirin and ticagrelor
Aspirin and clopidogrel

Related Resources

Downloadable Slide Kit

Adapting to DAPT: A Closer Look at Guidelines, Prescribing Habits, and Real-World Adherence

This slide kit highlights the different aspects of DAPT therapy, including recent guideline recommendations, P2Y12 inhibitor selection, outcomes of DAPT discontinuation, and strategies to encourage patient adherence.


Clinical Articles

Valgimigli M, Bueno H, Byrne RA, et al. 2-17 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39:213-260.  

Angiolillo DJ, Rollini R, Storey RF, et al. International expert consensus on switching platelet P2Y12 receptor-inhibiting therapies. Circulation. 2017;136:1955-1975.  

Franchi F, Rollini F, Rivas Rios J, et al. Pharmacodynamic effects of switching from ticagrelor to clopidogrel in patients with coronary artery disease: results of the SWAP (switching antiplatelet study)-4 study. Circulation. 2018;137:00-00. [Epub ahead of print].  

Berwanger O, et al. Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial. JAMA Cardiol. 2018. [Epub ahead of print].  

Bhatt DL, Bonaca MP, Bansilal S, et al. Reduction in ischemic events with ticagrelor in diabetic patients with prior myocardial infarction in PEGASUS-TIMI 54. J Am Coll Cardiol. 2016;67:2732-2740.  

Bonaca MP, Bhatt DL, Steg PG, et al. Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction: insights from PEGASUS-TIMI 54. Eur Heart J. 2016;37:1133-1142.  

Bonaca MP, Bhatt DL, Oude Ophuis T, et al. Long-term tolerability of ticagrelor for the secondary prevention of major adverse cardiovascular events: a secondary analysis of the PEGASUS-TIMI 54 trial. JAMA Cardiol. 2016;1:425-432.  

Giustino G, Chieffo A, Palmerini T, et al. Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol. 2016;68:1851-1864.  

Giustino G, Mehran R, Dangas GD, et al. Characterization of the average daily ischemic and bleeding risk after primary PCI for STEMI. J Am Coll Cardiol. 2017;70:1846-1857.  

Yeh RW, Kereiakes DJ, Steg PG, et al. Lesion complexity and outcomes of extended dual antiplatelet therapy after percutaneous coronary intervention. J Am Coll Cardiol. 2017;70:2213-2223.  

Costa F, van Klaveren D, James S, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389:1025-1034. 

Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 ACC/AHA guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134:e123-e155 

Sahlén A, Varenhorst C, Lagerqvist B, et al. Outcomes in patients treated with Ticagrelor or Clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry. Eur Heart J. 2016;37:3335-3342.  

Mega JL, Simon T. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. Lancet. 2015;386(9990):281-291. 

Steg G, Bhatt DL. Viewpoint: a proposal for a simple algorithm for managing oral anticoagulation and antiplatelet therapy in patients with non-valvular atrial fibrillation and coronary stents.  

Johnston SC, et al. Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (SOCRATES) trial: rationale and design. Int J Stroke. 2015;10:1304-1308. 

Related Links

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Steering Committee

Deepak L. Bhatt, MD, MPH

Steering Committee Co-Chair

Professor of Medicine, Harvard Medical School; Executive Director, Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart and Vascular Center, Boston, Massachusetts, United States

Keith A.A. Fox, MBChB, FRCP, FMedSci, FESC

Steering Committee Co-Chair

Professor of Cardiology, University of Edinburgh, Edinburgh, United Kingdom

Eric R. Bates, MD

Professor of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States

Marc P. Bonaca, MD, MPH

Assistant Professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States

Christopher P. Cannon, MD

Professor of Medicine, Harvard Medical School; Education Director, Cardiovascular Innovation; Cardiovascular Division, Brigham and Women's Hospital; Boston, Massachusetts, United States

Philippe Gabriel Steg, MD

Professor of Cardiology, Université Paris-Diderot, Paris, France