Cardiovasc Prev Pharmacother.  2022 Apr;4(2):63-69. 10.36011/cpp.2022.4.e11.

De-escalation strategies of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for acute coronary syndrome

• Song YB

• KMID: 2536922
• DOI: http://doi.org/10.36011/cpp.2022.4.e11

Abstract

Antiplatelet therapy is important for reducing systemic and local thrombotic events in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Antiplatelet treatment regimens, along with dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor for patients receiving PCI, have frequently changed over the years. With improvements in the understanding of the prognostic relevance of bleeding events in patients with PCI, as well as the safety and efficacy of drug-eluting stents, several randomized controlled trials (RCTs) have been conducted on antiplatelet treatment strategies associated with a more favorable balance between ischemic and bleeding risks. Several key RCTs for appropriate antiplatelet therapy in patients receiving PCI for ACS have been reported, and practical guidelines have been updated. This manuscript presents the results of major RCTs on de-escalation strategies of dual antiplatelet treatment in patients receiving PCI for ACS.

Keyword

Antiplatelet drugs; Percutaneous coronary intervention; Acute coronary syndrome

Figure

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  Fig. 1. Different methods of de-escalation strategies of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for acute coronary syndrome. TOPIC, Timing of Platelet Inhibition after Acute Coronary Syndrome; TALOS-AMI, Ticagrelor versus Clopidogrel in Stabilized Patients with Acute Myocardial Infarction; HOST-REDUCE-POLYTECH-ACS, Harmonizing Optimal Strategy for Treatment of Coronary Artery Diseases-Comparison of Reduction of Prasugrel Dose or Polymer Technology in Acute Coronary Syndrome Patients; TROPICAL-ACS, Testing Responsiveness To Platelet Inhibition On Chronic Antiplatelet Treatment For Acute Coronary Syndromes; POPular Genetics, CYP2C19 Genotype-Guided Antiplatelet Therapy in ST-Segment Elevation Myocardial Infarction Patients — Patient Outcome after Primary Percutaneous Coronary Intervention; TAILOR-PCI, Tailored Antiplatelet Initiation to Lesson Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention.

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