De-Escalation of Antiplatelet Treatment in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Review of the Current Literature

Figures

• 

  Figure 1. Strategies for dual antiplatelet therapy after PCI. The majority of patients undergoing percutaneous coronary intervention (PCI) should be treated with guideline recommended dual antiplatelet therapy (DAPT) (clopidogrel in elective PCI and ticagrelor or prasugrel in patients with acute coronary syndrome (ACS)). In elective PCI patients, an escalation strategy can be considered in some situations, when the thrombotic risk is higher than the bleeding risk. In ACS patients, de-escalation can be considered when the bleeding risk is higher than the thrombotic risk or for socio-economic considerations.

• 

  Figure 2. Recommended clopidogrel doses when de-escalating. When de-escalating from ticagrelor or prasugrel to clopidogrel in the early phase (≤30 days after the index event), a loading dose of 600mg should be administered 24 h after the last dose of the potent P2Y12 inhibitor. In the late phase (>30 days after the index event), a loading dose of 600 mg should only be administered from ticagrelor to clopidogrel, while a maintenance dose of 75 mg should be administered when de-escalating from prasugrel to clopidogrel. If de-escalating due to bleeding or bleeding concerns, a 75 mg clopidogrel dose could be considered instead of a loading dose irrespective of the phase or initial P2Y12 inhibitor.