Key result
Ticagrelor DAPT de-escalation may reduce bleeding without increasing ischemic events in selected ACS patients.
Why the study?
Potent DAPT with ticagrelor reduces ischemic risk after ACS but increases bleeding, prompting the need to review evidence on ticagrelor-based DAPT de-escalation strategies.
Does de-escalation of ticagrelor-based DAPT reduce bleeding risk without significantly increasing ischemic events in patients with acute coronary syndrome?
Does de-escalation of ticagrelor-based DAPT reduce bleeding risk without significantly increasing ischemic events in patients with acute coronary syndrome?
De-escalation of ticagrelor-based DAPT offers a viable strategy to reduce bleeding complications without compromising ischemic protection in selected patients with acute coronary syndrome.
Supports de-escalation in selected ACS patients; extends evidence for personalized DAPT strategies.
In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as ticagrelor is a cornerstone of treatment for preventing recurrent ischemic events and stent thrombosis. However, the use of potent antiplatelet agents is associated with an increased risk of bleeding, which may result in prolonged hospital stays, increased morbidity and mortality, and interruption of antiplatelet therapy. The incidence of bleeding complications is influenced by patient-related factors, disease characteristics, and treatment-related variables. The purpose of this narrative review is to provide an overview of currently available evidence on de-escalation strategies of ticagrelor-based DAPT and to identify key factors influencing their clinical application in patients with ACS. A literature search was conducted using electronic databases such as PubMed, Google Scholar, ScienceDirect, and SpringerLink to identify relevant studies published between 2005 and 2024. The findings suggest that de-escalation strategies, including switching to less potent P2Y12 inhibitors, shortening the duration of therapy, or adopting guided approaches, may reduce bleeding risk without significantly increasing ischemic events in selected patients. Early identification of high-risk individuals and appropriate implementation of tailored de-escalation strategies are essential to minimize complications and improve overall clinical outcomes.
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M et al. (2026) conducted a review in Acute Coronary Syndrome. De-escalation of ticagrelor-based dual antiplatelet therapy vs. Standard dual antiplatelet therapy was evaluated. De-escalation strategies of ticagrelor-based dual antiplatelet therapy may reduce bleeding risk without significantly increasing ischemic events in selected patients with acute coronary syndrome.
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