De-Escalating Antiplatelet Therapy: A Promising Concept

Tailored therapy based on platelet function testing after an acute coronary syndrome and percutaneous coronary intervention was noninferior to usual care.

Prasugrel has shown superiority over clopidogrel with regard to cardiovascular outcomes in patients with an acute coronary syndrome and percutaneous coronary intervention, but it comes with an increased bleeding risk. In the manufacturer-supported TROPICAL-ACS trial (NCT01959451), researchers tested the effect of a de-escalation antiplatelet strategy, guided by platelet function testing (PFT) in 2610 patients, who were randomized to standard versus tailored de-escalation dual antiplatelet therapy (DAPT).

Standard therapy consisted of aspirin plus prasugrel for 12 months. “Tailored therapy” involved 1 week of prasugrel, followed by 1 week of clopidogrel, which was followed by a PFT-guided maintenance therapy starting 2 weeks after the index e…

Reviewing Author

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Leadership Positions in Professional SocietiesEuropean Society of Cardiology (Communication Committee); European Association of Percutaneous Cardiovascular Interventions (Chair, Web & Communication Committee)

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

De-Escalating Antiplatelet Therapy: A Promising Concept

Topics

Reviewing Author