De-Escalation of Treatment With Oral P2Y12 Receptor Inhibitors: Current Status and Perspectives.
Dimitrios AlexopoulosIoannis LianosPanagiotis VlachakisDanai SfantouVassiliki-Maria DragonaCharalambos VarlamosPublished in: Journal of cardiovascular pharmacology and therapeutics (2019)
In patients with an acute coronary syndrome undergoing percutaneous coronary intervention, novel P2Y12 receptor inhibitors, prasugrel and ticagrelor, are proposed as "first-line" antiplatelet agents in the absence of contraindications and up to a year from the index event. However, de-escalation of treatment to clopidogrel occurs with a variable frequency in real-life practice, most commonly due to an increased bleeding potential, more frequent side effects, and a higher cost for the novel agents. Pharmacodynamic studies provide most of the data on guidance for de-escalation. Despite positive messages from recent trials and registries, lack of definitive efficacy or safety results of such a strategy remains an obstacle to suggest de-escalation in a routine basis. Carefully designed studies are likely to improve our understanding of the impact of de-escalation and help to better define its position in current pharmacotherapy.
Keyphrases
- percutaneous coronary intervention
- acute coronary syndrome
- antiplatelet therapy
- open label
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- acute myocardial infarction
- coronary artery disease
- coronary artery bypass grafting
- current status
- atrial fibrillation
- primary care
- deep learning
- machine learning
- smoking cessation
- human health
- study protocol
- replacement therapy