• Sanam Verma, Shaun G Goodman, Mary K Tan, Benoit Daneault, Bruce J Lubelsky, Samer Mansour, Andy S Lam, David Laflamme, Wayne J Tymchak, Robert C Welsh, Randi C Rose, Rajendra M Chetty, Christian M Constance, Tomas Cieza, Brian J Potter, Michael C Hartleib, Razi Khan, Richard F Choi, William Keeble, Jean-Pierre Dery, Dinkar Shukla, Grace L Chua, and Kevin R Bainey.
• Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
• Int. J. Clin. Pract. 2021 Oct 1; 75 (10): e14597.

BackgroundAlthough acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada.MethodsCanadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy-like criteria from May 2018 to April 2019.ResultsOf the 492 (two cardiologists provided 11 patients) enroled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularisation was common (percutaneous coronary artery intervention 61%, coronary artery bypass graft 39%), with 31% having multivessel disease. A total of 47% of patients had a Reduction of Atherothrombosis for Continued Health bleeding score of ≥11 (~2.8% risk of serious bleeding at 2 years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC), with 16% being on non-vitamin K oral anticoagulant alone, 5% on DPI and 1% received triple therapy.ConclusionsIn contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk.© 2021 John Wiley & Sons Ltd.

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