Escalation and De-Escalation of Antiplatelet Therapy after Acute Coronary Syndrome or PCI: Available Evidence and Implications for Practice

被引:3
|
作者
Gragnano, Felice [1 ,2 ]
Capolongo, Antonio [1 ,2 ]
Terracciano, Fabrizia [1 ,2 ]
Gargiulo, Giuseppe [1 ,3 ]
De Sio, Vincenzo [1 ,2 ]
Cesaro, Arturo [1 ,2 ]
Moscarella, Elisabetta [1 ,2 ]
Patti, Giuseppe [4 ]
Porto, Italo [5 ]
Esposito, Giovanni [3 ]
Angiolillo, Dominick J. [6 ]
Calabro, Paolo [1 ,2 ]
机构
[1] Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, I-80131 Naples, Italy
[2] Azienda Osped Sant Anna San Sebastiano, Div Cardiol, I-81100 Caserta, Italy
[3] Univ Naples Federico II, Dept Adv Biomed Sci, I-80131 Naples, Italy
[4] Univ Piemonte Orientale, Dept Translat Med, I-28100 Novara, Italy
[5] Univ Genoa, Div Cardiovasc Med, Policlin San Martino, I-16132 Genoa, Italy
[6] Univ Florida, Div Cardiol, Coll Med, Jacksonville, FL 32209 USA
关键词
de-escalation; escalation; DAPT; guided-therapy; aspirin; OPEN-LABEL; MYOCARDIAL-INFARCTION; PLATELET REACTIVITY; NON-INFERIORITY; INTERVENTION; CLOPIDOGREL; MULTICENTER; TICAGRELOR; PRASUGREL; IMPLANTATION;
D O I
10.3390/jcm11216246
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Dual antiplatelet therapy (DAPT) is the gold standard for the antithrombotic management of patients with an acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Implementation of intensified or prolonged DAPT regimens has proven to lower the risk of ischemic events but at the expense of increased bleeding. Importantly, bleeding is a predictor of poor prognosis. Risk stratification and selection of tailored antiplatelet strategies to maximize the net clinical benefit in individual patients with ACS or undergoing PCI is therefore potentially beneficial. Recently, novel approaches including DAPT de-escalation or escalation have been proposed as possible alternatives to standard DAPT. These strategies, which are generally based on patient's risk profile, genetics, and/or platelet function have been proposed to offer more tailored treatments in patients with ACS or PCI, with the ultimate goal of providing adequate ischemic protection while mitigating the risk of bleeding. This review summarizes the available evidence on DAPT de-escalation or escalation (both guided and unguided) and discusses the practical implications of these strategies in the contemporary management of patients with ACS and/or undergoing PCI.
引用
收藏
页数:13
相关论文
共 50 条
  • [41] De-Escalation of Dual Antiplatelet Therapy: Will We Ever Get to the Right Method?
    Calcagno, Simone
    Corcione, Nicola
    Biondi-Zoccai, Giuseppe
    Giordano, Arturo
    JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 2022, 80 (02) : 203 - 205
  • [42] De-Escalation of Dual Antiplatelet Regimens in East Asian Patients Undergoing Coronary Intervention
    Kim, Moo Hyun
    Choi, Sun Young
    Serebruany, Victor
    AMERICAN JOURNAL OF THERAPEUTICS, 2020, 27 (06) : E611 - E612
  • [43] Short Duration of DAPT vs De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes
    Li, Juan
    Li, Qing
    Wang, Jingyu
    Zhao, Xinke
    Li, Yingdong
    JACC-CARDIOVASCULAR INTERVENTIONS, 2022, 15 (09)
  • [44] Smoking and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS smoking substudy
    Orban, M.
    Trenk, D.
    Rieber, J.
    Geisler, T.
    Hadamitzky, M.
    Komosa, A.
    Gross, L.
    Orban, M. W.
    Huber, K.
    Felix, S. B.
    Huczek, Z.
    Jacobshagen, C.
    Aradi, D.
    Massberg, S.
    Sibbing, D.
    EUROPEAN HEART JOURNAL, 2018, 39 : 764 - 765
  • [45] Gender and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS gender substudy
    Gross, L.
    Trenk, D.
    Geisler, T.
    Hadamitzky, M.
    Loew, A.
    Orban, M.
    Huber, K.
    Kiss, R. G.
    Merkely, B.
    Huczek, Z.
    Beuthner, B. E. C.
    Massberg, S.
    Aradi, D.
    Jacobshagen, C.
    Sibbing, D.
    EUROPEAN HEART JOURNAL, 2018, 39 : 1063 - 1063
  • [46] CLINICAL OUTCOMES ASSOCIATED WITH DE-ESCALATION FROM TICAGRELOR TO CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME
    Angiolillo, Dominick
    Shah, Roshan
    Paek, Dara
    Sayre, Toby
    Clausel, Alicia
    Girotra, Shalini
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2018, 71 (11) : 1199 - 1199
  • [47] Gender and Outcomes following Guided De-Escalation of Antiplatelet Treatment in Acute Coronary Syndrome Patients: The TROPICAL-ACS Gender Substudy
    Gross, Lisa
    Kupka, Danny
    Trenk, Dietmar
    Geisler, Tobias
    Hadamitzky, Martin
    Loew, Anja
    Orban, Martin
    Huber, Kurt
    Kiss, Robert Gabor
    Merkely, Bela
    Huczek, Zenon
    Beuthner, Bo Eric
    Hein-Rothweiler, Ralph
    Baylacher, Monika
    Rizas, Konstantinos
    Massberg, Steffen
    Aradi, Daniel
    Sibbing, Dirk
    Jacobshagen, Claudius
    THROMBOSIS AND HAEMOSTASIS, 2019, 119 (09) : 1527 - 1538
  • [48] Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes
    Laudani, Claudio
    Greco, Antonio
    Occhipinti, Giovanni
    Ingala, Salvatore
    Calderone, Dario
    Scalia, Lorenzo
    Agnello, Federica
    Legnazzi, Marco
    Mauro, Maria Sara
    Rochira, Carla
    Buccheri, Sergio
    Mehran, Roxana
    James, Stefan
    Angiolillo, Dominick J.
    Capodanno, Davide
    JACC-CARDIOVASCULAR INTERVENTIONS, 2022, 15 (03) : 268 - 277
  • [49] De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis
    Diana A. Gorog
    Jose Luis Ferreiro
    Ingo Ahrens
    Junya Ako
    Tobias Geisler
    Sigrun Halvorsen
    Kurt Huber
    Young-Hoon Jeong
    Eliano P. Navarese
    Andrea Rubboli
    Dirk Sibbing
    Jolanta M. Siller-Matula
    Robert F. Storey
    Jack W. C. Tan
    Jurrien M. ten Berg
    Marco Valgimigli
    Christophe Vandenbriele
    Gregory Y. H. Lip
    Nature Reviews Cardiology, 2023, 20 : 830 - 844
  • [50] De-Escalation of Antiplatelet Therapy in Elderly or Low-Weight Patients With Myocardial Infarction
    Kim, Yonghee
    Choo, Eun Ho
    Kim, Yeo Reum
    Chang, Kiyuk
    Kim, Do Young
    Roh, Kyung Hoon
    Seung, Jaeho
    Lee, Hyunki
    Shin, Changyong
    Hwang, Byung-Hee
    Lee, Jung Hyuck
    Jung, Moon Kyung
    Shin, Sanghoon
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2023, 82 (17) : B264 - B265