New in Clinical Guidance | Antiplatelets in ASCVD; DOACs in Preventing Thrombotic Events; Global HF Definition
ACC Scientific Statement Guides Antiplatelet Therapy in ASCVD
An ACC Scientific Statement on managing ASCVD aims to help clinicians overcome the perpetual challenge of balancing the risks of ischemia and bleeding when selecting antiplatelet therapy in this population.
Chaired by Dharam J. Kumbhani, MD, SM, FACC, and published in JACC, the Statement summarizes pivotal clinical trials and compares current ACC/AHA and European Society of Cardiology guidance for acute coronary syndrome (ACS), chronic coronary disease and chronic coronary syndromes.
Consensus recommendations address ischemic vs. bleeding risk in determining antiplatelet strategy, aspirin for primary prevention, perioperative management and patient monitoring, as well as antiplatelet therapy after revascularization and long-term after ASC or myocardial infarction. The document also reviews considerations for peripheral artery disease, stroke/TIA, valve disease and patients requiring anticoagulation.
The authors emphasize medication adherence, suggesting multifaceted strategies such as early post-discharge follow-up, culturally sensitive patient education, attention to social drivers of health and financial burden, monitoring for bleeding, dose adjustment or de-escalation when appropriate, and possible fixed-dose polypill combinations.
DOAC Guidance Targets Thrombotic Event Prevention
Despite robust evidence for their efficacy and safety, direct oral anticoagulants (DOACs) remain underused and sometimes inappropriately dosed, particularly in patients at elevated thrombotic risk. An ACC Scientific Statement published in JACC provides evidence-based guidance on DOAC use for primary and secondary prevention of thrombotic events.
The Statement reviews key guideline recommendations and established and emerging indications for DOAC therapy. Consensus recommendations address primary prevention of venous thromboembolism (VTE) and stroke; management and secondary prevention of VTE; and secondary prevention after acute stroke, left atrial appendage closure and ablation for atrial fibrillation.
It also covers DOAC management in special populations, including patients with chronic kidney disease, liver disease, frailty, obesity, prior bleeding or cancer-associated thrombus. Practical considerations include drug selection, dosing strategies, duration of therapy, bleeding risk assessment, management of anticoagulant-related bleeding, drug-drug interactions, adherence and cost-related barriers.
The Writing Committee, chaired by Dharam J. Kumbhani, MD, SM, FACC, notes the Statement is intended to complement existing guidelines by synthesizing evolving data, clarifying uncertainty and supporting individualized, patient-centered decision-making to improve appropriate and equitable DOAC use.
Global HF Definition Updated to Improve Prevention, Diagnosis, Treatment
The AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (HF) addresses evolving disease manifestations, diagnostic strategies and pathophysiology, offering one unified definition for clinicians, researchers, health systems and policymakers worldwide.
Published on behalf of the ACC, AHA, European Society of Cardiology and World Heart Federation, in collaboration with the Heart Failure Society of America, ESC Heart Failure Association and the Japanese Heart Failure Society, the document updates the First Universal Definition of Heart Failure released in 2021.
Key changes include a universal classification system for HF causes to standardize reporting across registries and trials, and a shift away from strict LVEF cutoffs that may obscure treatment benefits across HF phenotypes. The definition instead accounts for factors such as age, sex and ethnicity and groups HF into reduced, preserved and improved EF categories to better reflect clinical realities.
The document also emphasizes earlier intervention, mitigation of progression to advanced HF and recognition of HF as a dynamic disease with potential for improvement, remission and recovery. It also underscores the impact of access to care, geography, policy and social drivers of health on HF risk and outcomes.
"HF remains a major challenge that continues to grow globally, and inconsistencies in how it is defined have limited progress in research and treatment," said Mary Norine Walsh, MD, MACC, co-chair of the document. "This updated definition provides a clearer, more consistent framework to help clinicians identify risk earlier and guide more personalized treatment approaches that can help improve patient outcomes worldwide."
According to the ACC and AHA, the definition will serve as the foundation for the upcoming Heart Failure Guideline, expected in late 2027.
Enhanced Radiation Protection In Cath Labs
A new expert consensus statement calls for immediate adoption of safer technologies to protect health care professionals. Read the full details from this multisociety document endorsed by the ACC and published in JACC: Cardiovascular Interventions.
Clinical Topics: Anticoagulation Management, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure
Keywords: Cardiology Magazine, ACC Publications, CM-Sep-2026, Global Health, Heart Failure, Anticoagulants, Dual Anti-Platelet Therapy
