Short dual antiplatelet therapy followed by P2Y12-inhibitor monotherapy and DAPT de-escalation reduce bleeding complications without increasing ischemic events compared to standard DAPT after PCI.
Does shortening or de-escalating DAPT reduce bleeding complications without increasing ischemic events in patients with ACS/CCS undergoing PCI?
Shortening or de-escalating DAPT strategies can reduce bleeding complications without compromising ischemic protection in high-risk cardiovascular patients.
Dual antiplatelet therapy (DAPT) for 6–12 months, followed by lifelong aspirin monotherapy is considered an effective standard therapy for the prevention of thrombo-ischemic events in patients with acute and chronic coronary syndrome (ACS, CCS) undergoing percutaneous coronary intervention (PCI) or after a primarily conservative treatment decision. In ACS patients, the stronger P2Y 12 -inhibitors ticagrelor or prasugrel are recommended in combination with aspirin unless the individual bleeding risk is high and shortening of DAPT is warranted or clopidogrel is preferred. However, also in patients at low individual bleeding risk, DAPT is associated with a higher risk of bleeding. In recent years, new antithrombotic treatment strategies, such as shortening DAPT followed by early P2Y 12 -inhibitor monotherapy and de-escalating DAPT from potent P2Y 12 -inhibitors to clopidogrel by maintaining DAPT duration time, have been investigated in clinical trials and shown to reduce bleeding complications in cardiovascular high-risk patients without negative effects on ischemic events. In this review, we summarize the current knowledge and discuss its implication on future antithrombotic strategies in terms of a personalized medicine.
Muthspiel et al. (Thu,) conducted a review in Acute and chronic coronary syndrome undergoing percutaneous coronary intervention. Short dual antiplatelet therapy and DAPT de-escalation vs. Standard dual antiplatelet therapy was evaluated. Short dual antiplatelet therapy followed by P2Y12-inhibitor monotherapy and DAPT de-escalation reduce bleeding complications without increasing ischemic events compared to standard DAPT after PCI.