Atlantic Anti-Platelet Guidelines Panel Commentary Videos

The primary goal of the Atlantic Anti-Platelet Initiative (AAPI) was to develop evidence-based guidelines for the acute administration of oral anti-platelet therapy in patients presenting with ACS throughout Atlantic Canada. Although dual anti-platelet therapy with aspirin and clopidogrel is well established as the regional standard of care, uncertainty exists regarding how the novel P2Y12 inhibitors prasugrel and ticagrelor should be incorporated into clinical practice.

The AAPI recommendations differ from both the National CCS and ESC guidelines based primarily on the typical demographics of the Atlantic Canada ACS patient population. Please take the time to review the AAPI Panelist video’s where insight on the factors that influenced their decision-making are presented.

Michael P. Love

Michael P. Love

MD, MB, ChB, MRCP

Interventional Cardiologist
AAPI Steering Committee Chair
Queen Elizabeth II Health Sciences Centre
Halifax, Nova Scotia

Michael P. Love MD, MB, ChB, MRCP

  1. What drove the decision to create Atlantic acute coronary syndrome guideline?
  2. What body of clinical evidence did the Panel review and consider while forming the recommendations and how were subgroup analyses utilized?
  3. The AAPI Guideline primarily recommends a Selective vs. Universal approach to the use of the newer antiplatelet medications, what considerations influenced that decision?
  4. What body of evidence was used to support a switch between antiplatelet agents?
  5. What role do you foresee for Inter-Provincial clinical committees such as these during the reimbursement process?
  6. What are the key messages the Panel would like to share with Atlantic clinicians via the AAPI recommendations?
Vernon Paddock

Vernon Paddock

MD, FRCPC

Interventional Cardiologist & Chief of Cardiology
Saint John Regional Hospital
Saint John, New Brunswick

Vernon Paddock MD, FRCPC

  1. Why was there a need to create an Atlantic acute coronary syndrome guideline?
  2. What body of clinical evidence did the Panel review and consider during recommendation decision-making?
  3. What evidence was used to support a switch between antiplatelet agents?
  4. What role do you foresee for inter-Provincial clinical committees such as these during the reimbursement process?
  5. The AAPI Guideline primarily recommends a Selective vs. Universal approach when prescribing the newer antiplatelet medications, what factors influenced that decision?
  6. Appreciating there was consensus between AAPI Panel members, was there similar agreement by Secondary Panelists who reviewed the recommendations?
  7. Why do the AAPI recommendations differ from the National CCS Antiplatelet and ECS guidelines if each of the committee’s evaluated the same body of clinical evidence?
Barry Rose

Barry Rose

MD, FRCPC, FACC

Barry Rose MD, FRCPC, FACC
Interventional Cardiologist
Chief of Cardiology (Eastern Health)
Assistant Professor, Memorial University
St. John’s, Newfoundland

Barry Rose MD, FRCPC, FACC

  1. Why was there a need to create an Atlantic acute coronary syndrome guideline?
  2. The AAPI Guideline primarily recommends a Selective vs. Universal approach when using the newer antiplatelet medications, what considerations influenced that decision?
  3. What evidence was used to support a switch between antiplatelet medications?
  4. Appreciating there was consensus between AAPI Panel members, was there similar agreement by Secondary Panelists?
  5. What role do you foresee for Inter-Provincial clinical committees such as these during the reimbursement process?
  6. What are the key messages the Panel would like to share with Atlantic clinicians via the AAPI recommendations?
Michel D’Astou

Michel D’Astou

MD, FRCPC

Clinical Professor, Sherbrooke University
Cardiologie — Dr. Georges L. Dumont Hospital
Moncton, New Brunswick

Michel D’Astou MD, FRCPC

  1. Pourquoi y avait-il un besoin de créer des lignes directrices sur les syndromes coronariens aigus (SCA) au Canada atlantique?
  2. Comment la région de l’Atlantique était-elle représentée dans la composition du comité AAPI?
  3. Du point de vue d’un cardiologue, comment qualifieriez-vous le processus d’élaboration des lignes directrices de l’AAPI?
  4. Pourquoi les recommandations de l’AAPI diffèrent-elles des lignes directrices nationales de la SCC sur les antiplaquettaires ainsi que celles de la SEC, étant donné que les mêmes preuves cliniques ont été évaluées?
  5. Il semblerait que vos recommandations visent principalement à appuyer l’utilisation continue de Clopidogrel chez les patients atteints du SCA au Canada atlantique. Compte tenu des données supérieures sur la mortalité, pourquoi les nouveaux antiplaquettaires n’ont-ils pas occupé une place plus importante dans les lignes directrices?
  6. Quels sont les messages clés que le comité voudrait transmettre aux cliniciens du Canada atlantique par l’entremise des recommandations de l’AAPI?
Mike Callaghan

Mike Callaghan

BSc. (Pharm)

Michael Callaghan BSc. (Pharm)
Clinical Pharmacist in Cardiology
Capital District Health Authority
Halifax, Nova Scotia

Mike Callaghan BSc. (Pharm)

  1. As a Hospital Pharmacist, how would you characterize the process through which these recommendations were generated?
  2. How do these recommendations impact care within and between hospitals throughout Atlantic Canada?
  3. Considering the mortality benefit, why did the Panel not recommended a broader use of the newer antiplatelet agents such as ticagrelor in emergency departments throughout Atlantic Canada?
  4. Considering clopidogrel’s inter-patient variability of antiplatelet effect and prominence of that molecule throughout the AAPI recommendations, how confident was your Panel with generic clopidogrel being prescribed for ACS patients?
  5. How do payers throughout Atlantic Canada view the AAPI recommendations?
Rachel Harris

Rachel Harris

BSc. (Pharm), PharmD.

Rachel Harris BSc. (Pharm), PharmD.
Clinical Pharmacist in Cardiology
Saint John Regional Hospital
Saint John, New Brunswick

Rachel Harris BSc. (Pharm), PharmD.

  1. As a Hospital Pharmacist, how would you describe the process through which these recommendations were generated?
  2. How do these recommendations impact care within and between hospitals throughout Atlantic Canada?
  3. Considering the mortality benefit, why did the Panel not recommended a broader use of the newer antiplatelet agents such as ticagrelor in emergency departments throughout Atlantic Canada?
  4. Considering clopidogrel’s established inter-patient variability and prominence of that molecule within the AAPI recommendations, how confident was your Panel with generic clopidogrel being prescribed for acute coronary syndrome patients?
  5. How do payers throughout Atlantic Canada view the AAPI recommendations?
Kim D Kelly

Kim D Kelly

BSc. (Pharm)

Drug Evaluation Unit Pharmacist
Capital District Health Authority
Halifax, Nova Scotia

Kim D Kelly BSc. (Pharm)

  1. As a Hospital Pharmacist, how would you describe the process through which these recommendations were generated?
  2. How do these recommendations impact care within and between hospitals throughout Atlantic Canada
  3. Considering the mortality benefit, why did the Panel not recommended a broader use of the newer antiplatelet agents such as ticagrelor in emergency departments throughout Atlantic Canada?
  4. Considering clopidogrel’s established inter-patient variability and prominence of that molecule within the AAPI recommendations, how confident was your Panel with generic clopidogrel being prescribed for acute coronary syndrome patients?
  5. Do payers from throughout Atlantic Canada hold an opinion on the AAPI recommendations?
David Marr

David Marr

MD, FRCPC, FACC

Associate Professor, Memorial and Dalhousie Universities
Cardiologist, Saint John Regional Hospital
Saint John, New Brunswick

David Marr MD, FRCPC, FACC

  1. From a cardiologist’s perspective, how would you describe the guideline development process?
  2. Why did the Atlantic Cardiovascular Society decide to endorse this Initiative and what role did it play?
  3. Considering the common body of published clinical evidence, why do the AAPI recommendations differ from the National CCS Antiplatelet and ECS guidelines?
  4. What is the Provincial payer stance on the AAPI recommendations?
  5. What are the practical messages community physicians should consider when applying the AAPI recommendations?
Neil Pearce

Neil Pearce

MD, FRCPC

Interventional Cardiologist & Director of the Cardiac Catheterization laboratory (Eastern Health)
Assistant Professor, Memorial University
St. John’s, Newfoundland

Neil Pearce MD, FRCPC

  1. As a Cardiologist how would you portray the guideline development process?
  2. What body of clinical evidence did the Panel review and consider during the development of the recommendations?
  3. Why do the AAPI recommendations differ from the National CCS Antiplatelet and ESC guidelines if all of the committee’s evaluated the same body of clinical evidence?
  4. The AAPI Guideline primarily recommends a Selective vs. Universal approach with the newer antiplatelet medications, what considerations influenced that decision?
  5. What are the key messages the Panel conveyed to Atlantic clinicians via the AAPI recommendations?
  6. What is the Provincial payer stance on the AAPI recommendations?
Michael Scott

Michael Scott

Patient Representative
Chairman of the Board
Precision BioLogic.
Dartmouth, Nova Scotia

Michael Scott

  1. How did you become involved with the AAPI Panel?
  2. What key insights did you observed during your participation in this guideline creation process?
  3. When reflecting upon the experience, what are the most relevant points you would share with the audience?
Scott Wilson

Scott Wilson

MD, CCFP (EM)

Emergency Room Physician
Regional Clinical Chief of Emergency Medicine and Performance (Eastern Health)
St. John’s, Newfoundland

Scott Wilson

  1. As an Emergency room physician, how would you characterize the process through which these recommendations were generated?
  2. How do these AAPI recommendations impact care within and between hospitals throughout Atlantic Canada
  3. Considering the mortality benefit, why did the Panel not recommended a broader use of the newer antiplatelet agents such as ticagrelor in emergency departments throughout Atlantic Canada?
  4. What are the key messages the Panel conveyed to Emergency Department Physicians via the AAPI recommendations?
Stephanie Young

Stephanie Young

BSc. (Pharm), ACPR, PharmD., MSc. (Med)

BSc. (Pharm), ACPR, PharmD., MSc. (Med)
Assistant Professor, School of Pharmacy, Memorial University
Clinical Pharmacotherapy Specialist, (Eastern Health) St. John’s, Newfoundland

Stephanie Young

  1. As a Hospital Pharmacist, how would you describe the process through which these recommendations were generated?
  2. How do the AAPI recommendations impact care within and between hospitals throughout Atlantic Canada
  3. Considering the mortality benefit, why did the Panel not recommended a broader use of the newer antiplatelet agents such as ticagrelor in emergency departments throughout Atlantic Canada?
  4. Considering clopidogrel’s established inter-patient variability, how confident was your Panel with recommending generic clopidogrel for Atlantic acute coronary syndrome patients?
  5. How do payers throughout Atlantic Canada view the AAPI recommendations?
Kevin McKenzie

Kevin McKenzie

Kevin McKenzie
AAPI Project Manager
Halifax, Nova Scotia

Kevin McKenzie

  1. How did the project originate?
  2. How was the AAPI project funded?
  3. How did the Panel composition represent the Atlantic Region?
  4. What process was used to generate the AAPI recommendations?