Why the study?
There is a need for compelling clinical evidence to guide decisions on de-escalating DAPT from ticagrelor or prasugrel to clopidogrel in patients with recent ACS.
Does early de-escalation from prasugrel or ticagrelor to clopidogrel improve safety without compromising efficacy in patients with acute coronary syndrome treated with percutaneous interventions?
Does early de-escalation from prasugrel or ticagrelor to clopidogrel improve safety without compromising efficacy in patients with acute coronary syndrome treated with percutaneous interventions?
This review highlights the need for compelling clinical evidence to guide the de-escalation of dual antiplatelet therapy from potent P2Y12 inhibitors to clopidogrel in ACS patients.
May support individualized DAPT de-escalation in select ACS patients; leaves open need for dedicated RCTs before practice change.
Dual antiplatelet treatment (DAPT) is the treatment of choice to prevent atherothrombotic events in patients with acute coronary syndrome (ACS) treated with percutaneous interventions (PCIs). The availability of different P2Y12 inhibitors set the stage for costum made DAPT, as to achieve the highest profile of safety and efficacy. The de-escalation therapy for the newer and more powerful antiplatelet drugs, such as ticagrelor and prasugrel, to clopidogrel, is a strategy for patients with recent ACS, unfit for continuing DAPT for their high risk of bleeding, or side effects, or socio-economic reasons, but without a prohibitive ischaemic risk. There is a need for compelling clinical evidences able to provide the clinical cardiologist with the necessary information to decide the best antiplatelet strategy for each individual patient.
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Masiero et al. (2020) studied this question.
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