1. De-Escalation of P2Y12 Receptor Inhibitor Therapy after Acute Coronary Syndromes in Patients Undergoing Percutaneous Coronary Intervention
- Author
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Danny Kupka and Dirk Sibbing
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,medicine.medical_treatment ,DAPT de-escalation ,Review Article ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Internal medicine ,Internal Medicine ,Medicine ,030212 general & internal medicine ,Aspirin ,P2Y12 Inhibitors ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Clopidogrel ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,medicine.drug - Abstract
Dual antiplatelet therapy (DAPT) — a combination of a P2Y12 receptor inhibitor and aspirin — has revolutionized antithrombotic treatment. Potent P2Y12 inhibitors such as prasugrel and ticagrelor exhibit a strong and more consistent platelet inhibition when compared to clopidogrel. Therefore, ticagrelor and prasugrel significantly reduce ischemic events, but at an expense of an increased bleeding risk in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). These observations have engaged intensive clinical research in alternative DAPT regimens to achieve sufficient platelet inhibition with an acceptable bleeding risk. Our review focusses on P2Y12 receptor therapy de-escalation defined as a switch from a potent antiplatelet agent (ticagrelor or prasugrel) to clopidogrel. Recently, both unguided (platelet function testing independent) and guided (platelet function testing dependent) DAPT de-escalation strategies have been investigated in different clinical studies and both switching strategies could be possible options to prevent bleeding complications without increasing ischemic risk. In light of the still limited data currently available, future large-scale trials should accumulate more data on various DAPT de-escalation regimens with both ticagrelor and prasugrel in unguided and guided de-escalation approaches. In the current review we aim at summarizing and discussing the current evidence on this still emerging topic in the field of antiplatelet treatment.
- Published
- 2018