Early De-Escalation of Dual Antiplatelet Therapy After PCI in Acute Coronary Syndrome

Reducing prasugrel from 10 mg to 5 mg at 1 month reduced bleeding without an increase in ischemia.

Dual antiplatelet therapy (DAPT), often with a more potent thienopyridine than clopidogrel, is recommended for up to 1 year for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). To reduce bleeding after the early thrombotic period, various strategies have been tested. In this industry-funded Korean study (NCT02193971), investigators randomized 2338 patients to receive DAPT with aspirin and prasugrel (10 mg) for 1 year or to have prasugrel de-escalated to 5 mg at 1 month. Patients' mean age was 59 years; 11% were women, and all had ACS (14% ST-segment elevation myocardial infarction [STEMI], 25% non-STEMI, 61% unstable angina).

The primary outcome — a composite endpoint of death, MI, stent thromb…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)