“De-Escalation” of Dual Antiplatelet Therapy for Patients Undergoing PCI for Acute MI

A large, randomized trial demonstrated improved net benefit of switching from a potent P2Y12 inhibitor to a less-potent agent 1 month after acute myocardial infarction.

For patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI), 12 months of dual antiplatelet therapy (DAPT) with aspirin plus a highly potent platelet P2Y12 receptor antagonist (e.g., ticagrelor or prasugrel) is currently recommended. However, these highly potent regimens are also associated with increased risk for bleeding. Recent trials have demonstrated the ability to decouple ischemic benefit from bleeding risk by shortening the duration of DAPT or by stopping aspirin after several months while continuing P2Y12 inhibition. Now, researchers have tested an alternative approach — switching from a more-potent to a less-potent P2Y12 inhibitor after the early thrombotic risk has subsided.

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Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)