Coronary artery disease (CAD) poses a significant threat with respect to morbidity and mortality of patients. The life expectancy of a patient who has suffered myocardial infarction (MI) is compromised by approximately 10 years. Moreover, real world evidence suggests that the risk of a recurrent event in such patients persists for years after the index event. With lifestyle diseases on the rise in India, physicians need to be well-equipped to exercise sound scientific judgement when dealing with a patient suffering from CAD. There seems to exist a marked heterogeneity when it comes to the clinical care of these high-risk patients.

In response to this, we had decided to collaborate with eminent cardiologists across the nation to develop a consensus document titled “Consensus document on antiplatelet agents in coronary heart disease”. The goal of this undertaking was to gather key experts from the field of Cardiology for a scientific discussion centered around the use of antiplatelet therapy. It is a well-established fact that antiplatelets form the cornerstone of treatment of patients with CAD and/or those receiving stents. Optimizing antiplatelet therapy in the Indian scenario calls for careful consideration of several factors such as time to maximal inhibition, major adverse cardiac event (MACE) reduction, bleeding outcomes, cost, clinical profile of the Indian demographic, etc. The document discusses these aspects under the different presentations of CAD, i.e., stable CAD and ACS (unstable angina, NSTEMI and STEMI).

Stable CAD and ACS differ in terms of baseline risk, which is also reflected in their management approaches. Though the main claim to fame of dual antiplatelet therapy (DAPT), from the cardiologists’ perspective, was in preventing stent thrombosis, various clinical trials and registries have established its utility in prevention of atherothrombosis in general. The choice of the appropriate agents; however, should be made based on the pharmacological properties of the drugs, treatment strategy employed (invasive or conservative), as well as individual patient characteristics. It is crucial to find the balance between preventing a recurrent ischemic event, whilst keeping bleeding at bay. Duration of antiplatelet therapy is also a matter of intense debate across the globe and calls for a more personalized treatment strategy.

The resultant recommendations are intended to standardize the use of antiplatelet therapy and help alleviate the uncertainty pertaining to their use in the Indian context. It is a pleasure to release this during India Live 2019, and we gratefully acknowledge the collaborative efforts of all the contributors that led to the fruition of this consensus document. We sincerely hope that it will be well-received by the healthcare practitioners and that it succeeds in lending clarity during decision-making.