Why the study?
Does de-escalation of antiplatelet therapy (low-dose ticagrelor with or without aspirin) reduce bleeding without increasing ischemic events in patients with acute coronary syndrome?
Does de-escalation of antiplatelet therapy (low-dose ticagrelor with or without aspirin) reduce bleeding without increasing ischemic events in patients with acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
This editorial discusses the rationale for the ELECTRA-SIRIO 2 trial, which will test whether de-escalating ticagrelor dose and/or withdrawing aspirin improves safety and adherence without compromising efficacy in ACS patients.
According to European Society of Cardiology (ESC) guidelines [1-3], dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin is recommended for 12 months after acute coronary syndrome (ACS) to prevent adverse thrombotic events. Earlier DAPT termination is justified only in high bleeding risk patients Recently, Kubica et al. [4] proposed a DAPT de-escalation strategy based on the pathophysiological premises providing a rationale for a randomized clinical trial. They
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Kleinrok et al. (2021) conducted an editorial in Acute coronary syndrome. Ticagrelor dose reduction with or without aspirin vs. Standard-dose ticagrelor (90 mg b.i.d.) with aspirin was evaluated on First occurrence of type 2, 3 or 5 bleeding according to BARC criteria (safety) and composite of death, nonfatal MI, or nonfatal stroke (efficacy).
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