A new ACC Scientific Statement focused on the management of atherosclerotic cardiovascular disease, aims to help clinicians overcome the perpetual challenge of balancing the risk of ischemia with the risk of bleeding in this patient population.

The Scientific Statement, chaired by Dharam J. Kumbhani, MD, SM, FACC, and published in JACC, includes a summary of pivotal clinical trials and compares current recommendations from ACC/AHA and European Society of Cardiology (ESC) clinical guidelines for acute coronary syndrome (ACS), chronic coronary disease, and chronic coronary syndromes, respectively.

Recommendations

Consensus recommendations are provided for managing ischemic vs. bleeding risk in determining antiplatelet strategy, use of aspirin for primary prevention of ASCVD events, perioperative management of antiplatelet therapy, and patient monitoring. Additional guidance addresses the use of antiplatelet therapy after revascularization, as well as long-term following ASC or myocardial infarction. Special considerations for PAD, stroke, TIA, valve disease and patients requiring anticoagulation are also explored.

Mediation Adherence

Medication adherence is another important topic. According to the authors, "factors contributing to poor adherence include older age, polypharmacy, socioeconomic barriers, high drug costs, and medication-related adverse effects such as bleeding or dyspnea." They suggest multi-faceted strategies that may improve adherence, including "early post-discharge follow-up, culturally sensitive patient education, addressing social drivers of health such as financial burden, close monitoring for bleeding and other adverse effects, dose adjustment or deescalation of therapy when appropriate, and potentially the use of fixed-dose polypill combinations."