PFT-guided de-escalation from prasugrel to clopidogrel was safe and showed no significant interaction by atherothrombotic risk status in ACS patients.
Does platelet function testing-guided de-escalation of dual antiplatelet therapy from prasugrel to clopidogrel improve net clinical benefit in ACS patients with high atherothrombotic risk?
Early platelet function testing-guided de-escalation from prasugrel to clopidogrel is safe and effective in ACS patients regardless of their baseline atherothrombotic risk.
Absolute Event Rate: 0% vs 0%
Abstract Background Platelet function testing (PFT) –guided de-escalation of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been shown to reduce bleeding risk without increasing ischemic events. Patients with high atherothrombotic risk (ATR) remain a challenging subgroup for such strategies. This study evaluated the safety and efficacy of early PFT-guided DAPT de-escalation according to ATR status. Methods In the TROPICAL-ACS trial, 2, 610 ACS patients were randomized to standard 12-month prasugrel therapy or PFT-guided DAPT de-escalation. For this post hoc analysis, patients were stratified by ATR. High ATR was defined as age ≥65 years, polyvascular disease, or ≥2 risk factors (diabetes, smoking, or renal dysfunction). Hazard ratios (HR) for clinical endpoints were derived using multistate Cox regression. Results High-ATR patients (n=990) had a higher incidence of the primary net clinical benefit endpoint—composite of cardiovascular death, myocardial infarction, stroke, or BARC 2–5 bleeding—compared with low-ATR patients (n=1, 620) (11. 0% vs. 6. 7%; HR 1. 67, 95% CI 1. 28–2. 18; p0. 001). PFT-guided de-escalation showed no significant interaction by ATR status for the primary endpoint (high-ATR: 10. 5% vs. 11. 5%, HR 0. 90 0. 61–1. 32, p=0. 586; low-ATR: 5. 6% vs. 7. 7%, HR 0. 71 0. 48–1. 04, p=0. 082; pᵢnteraction=0. 394) or ischemic events (high-ATR: 3. 7% vs. 4. 4%, HR 0. 83 0. 44–1. 56; low-ATR: 1. 8% vs. 2. 6%, HR 0. 68 0. 35–1. 34; pᵢnteraction=0. 666). Conclusion Early PFT-guided de-escalation from prasugrel to clopidogrel was safe across atherothrombotic risk categories, supporting individualized DAPT optimization in ACS patients with both low and high ischemic risk.
Farhan et al. (Tue,) reported a other. PFT-guided de-escalation from prasugrel to clopidogrel was safe and showed no significant interaction by atherothrombotic risk status in ACS patients.