☆ 4.6 Review

De-escalation of antiplatelet therapy in acute coronary syndromes: Why, how and when?

FRONTIERS IN CARDIOVASCULAR MEDICINE (2022)

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Article Cardiac & Cardiovascular Systems

Role of platelet function and genetic testing in patients undergoing percutaneous coronary intervention

Mattia Galli et al.

Summary: Dual antiplatelet therapy (DAPT) is the standard treatment for patients undergoing percutaneous coronary intervention (PCI). However, using a standard DAPT regimen for all patients could result in suboptimal efficacy or high bleeding risk for certain individuals. Guided selection of P2Y12 inhibitors based on platelet function or genetic testing has shown promising results in achieving a better balance between bleeding and ischemic events at the individual patient level. This review focuses on the rationale and evidence for platelet function and genetic testing-guided antiplatelet therapy and explores their implications in the modern setting of patients undergoing PCI.

TRENDS IN CARDIOVASCULAR MEDICINE (2023)

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Article Cardiac & Cardiovascular Systems

Comparative effects of guided vs. potent P2Y(12) inhibitor therapy in acute coronary syndrome: a network meta-analysis of 61 898 patients from 15 randomized trials

Mattia Galli et al.

Summary: This study evaluates the safety and efficacy of guided vs. routine selection of potent P2Y(12) inhibitors in patients with acute coronary syndrome (ACS). The findings suggest that a guided selection of P2Y(12) inhibiting therapy provides a more favorable balance between safety and efficacy compared to routine selection.

EUROPEAN HEART JOURNAL (2022)

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Article Cardiac & Cardiovascular Systems

Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes

Claudio Laudani et al.

Summary: This study compares the effectiveness of short dual antiplatelet therapy (DAPT) and de-escalation in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The results suggest that de-escalation reduces the risk of adverse cardiovascular events, while short DAPT decreases the occurrence of major bleeding.

JACC-CARDIOVASCULAR INTERVENTIONS (2022)

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Article Cardiac & Cardiovascular Systems

ABCD-GENE Score and Clinical Outcomes Following Percutaneous Coronary Intervention: Insights from the TAILOR-PCI Trial

Davide Capodanno et al.

Summary: The ABCD-GENE score can identify high-risk patients who undergo percutaneous coronary intervention and use clopidogrel. It has the potential to improve the selection of P2Y(12) inhibitors, but further research is needed to confirm its effectiveness.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2022)

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Review Cardiac & Cardiovascular Systems

Bleeding avoidance strategies in percutaneous coronary intervention

Davide Capodanno et al.

Summary: As the field of PCI advances, the importance of bleeding in treatment is increasingly recognized, being seen as having equally unfavorable prognostic implications as ischemic or thrombotic complications. Therefore, strategies focusing on maximizing treatment efficacy while minimizing safety concerns such as bleeding have become increasingly important.

NATURE REVIEWS CARDIOLOGY (2022)

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Article Cardiac & Cardiovascular Systems

Guided and unguided de-escalation from potent P2Y12 inhibitors among patients with acute coronary syndrome: a meta-analysis

Anne H. Tavenier et al.

Summary: Based on analysis of five randomized controlled trials, DAPT de-escalation was associated with significant reduction in bleeding events and major adverse cardiac events compared to standard DAPT. Both unguided and guided DAPT de-escalation strategies, whether guided by genetic testing or platelet function testing (PFT), showed consistent lowering rates of bleeding and ischemic events.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY (2022)

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Article Cardiac & Cardiovascular Systems

Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome The STOPDAPT-2 ACS Randomized Clinical Trial

Hirotoshi Watanabe et al.

Summary: In patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy (DAPT) did not demonstrate noninferiority to 12 months of DAPT for the composite end point of cardiovascular and bleeding events.

JAMA CARDIOLOGY (2022)

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Review Pharmacology & Pharmacy

Precision medicine in interventional cardiology: implications for antiplatelet therapy in patients undergoing percutaneous coronary intervention

Mattia Galli et al.

Summary: Precision medicine proposes customized treatments for individual patients instead of a one-size-fits-all model. While widely adopted in cancer medicine, implementing precision medicine in cardiovascular medicine is more challenging. Personalized antiplatelet therapy is crucial for cardiovascular patients, but it is associated with bleeding risks. This review discusses the rationale, evidence, and future directions in personalizing antiplatelet treatment for patients undergoing percutaneous coronary intervention.

PHARMACOGENOMICS (2022)

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Review Cardiac & Cardiovascular Systems

Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention

Mattia Galli et al.

Summary: Percutaneous coronary intervention (PCI) is a relatively safe procedure, but is inevitably associated with short and mid-to-long term increased bleeding risk. Bleeding is an important prognostic factor and it is important to study strategies for reducing bleeding.

REVIEWS IN CARDIOVASCULAR MEDICINE (2022)

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Review Cardiac & Cardiovascular Systems

Antiplatelet therapy after percutaneous coronary intervention

Dominick J. Angiolillo et al.

Summary: Antiplatelet therapy is crucial for reducing thrombotic complications and ischemic events in patients undergoing percutaneous coronary interventions (PCI), but it is also associated with increased risk of bleeding. Advances in stent technologies and understanding of bleeding risks have led to the development of personalized antiplatelet treatment regimens. Recent research and guidelines have provided several options for antiplatelet therapy after PCI.

EUROINTERVENTION (2022)

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Article Cardiac & Cardiovascular Systems

Duration of dual antiplatelet therapy and subsequent monotherapy type in patients undergoing drug-eluting stent implantation: a network meta-analysis

Stefano Benenati et al.

Summary: Short and very short DAPT have similar efficacy to standard DAPT after DES implantation, while extended DAPT reduces the risk of MI. Very short DAPT followed by a P2Y(12) inhibitor is preferred to balance major bleeding and ischemic events.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY (2022)

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Article Cardiac & Cardiovascular Systems

Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials

Stefano Benenati et al.

Summary: Compared with long-term DAPT, very short-term DAPT did not increase the odds of ischemic complications in PCI patients, while reducing the odds of major or any bleeding by over 30%.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY (2021)

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Article Cardiac & Cardiovascular Systems

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Jean-Philippe Collet et al.

EUROPEAN HEART JOURNAL (2021)

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Review Cardiac & Cardiovascular Systems

Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey

Davide Cao et al.

Summary: Since its introduction in 1977, percutaneous coronary intervention has become one of the most commonly performed therapeutic procedures worldwide, with antithrombotic agents playing a crucial role in patient management. The past 40 years have seen significant advancements in interventional cardiology in both drug therapies and device technologies.

EUROPEAN HEART JOURNAL (2021)

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Review Pharmacology & Pharmacy

Safety and efficacy of P2Y12 inhibitor monotherapy in patients undergoing percutaneous coronary interventions

Mattia Galli et al.

Summary: Studies have shown that P2Y(12) inhibitor monotherapy after a brief course of DAPT can reduce the risk of bleeding while still preventing thrombotic complications in patients undergoing PCI.

EXPERT OPINION ON DRUG SAFETY (2021)

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Editorial Material Cardiac & Cardiovascular Systems

Guided selection of antiplatelet therapy in acute coronary syndrome: Impact on outcomes and resource utilization

Mattia Galli et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2021)

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Article Medicine, General & Internal

Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial

Chan Joon Kim et al.

LANCET (2021)

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Article Medicine, General & Internal

Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Mattia Galli et al.

LANCET (2021)

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Review Pharmacology & Pharmacy

Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations

Mattia Galli et al.

Summary: The study highlights the rationale for using genetic testing to guide the selection of platelet P2Y(12) inhibitors in patients undergoing PCI, with a focus on the impact of cytochrome P450 (CYP) 2C19 gene variations on clopidogrel metabolism and response profiles. It suggests that implementing genetic testing can lead to either escalation (switching to prasugrel or ticagrelor) or de-escalation (switching to clopidogrel) of P2Y(12) inhibiting therapy for better clinical outcomes in PCI patients.

EXPERT REVIEW OF CLINICAL PHARMACOLOGY (2021)

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Article Medicine, General & Internal

P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials

Marco Valgimigli et al.

Summary: The study assessed the risks and benefits of P2Y(12) inhibitor monotherapy compared with dual antiplatelet therapy, finding that P2Y(12) inhibitor monotherapy was associated with lower risk of primary ischemic endpoints and lower bleeding risk compared to DAPT.

BMJ-BRITISH MEDICAL JOURNAL (2021)

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Article Cardiac & Cardiovascular Systems

Efficacy and Safety of Ticagrelor Monotherapy by Clinical Presentation: Pre-Specified Analysis of the GLOBAL LEADERS Trial

Pascal Vranckx et al.

Summary: This study analyzed the outcomes of dual antiplatelet therapy after coronary drug-eluting stent placement in patients with stable coronary artery disease (SCAD) and acute coronary syndromes (ACS). It was found that the experimental strategy could reduce bleeding risk in ACS patients, but the effect was not significant in SCAD patients.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2021)

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Correction Cardiac & Cardiovascular Systems

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) (vol 42, pg 1289, 2021)

Jean-Philippe Collet et al.

EUROPEAN HEART JOURNAL (2021)

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Correction Cardiac & Cardiovascular Systems

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) (vol 42, pg 1289, 2021)

Jean-Philippe Collet

EUROPEAN HEART JOURNAL (2021)

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Article Cardiac & Cardiovascular Systems

Derivation, Validation, and Prognostic Utility of a Prediction Rule for Nonresponse to Clopidogrel The ABCD-GENE Score

Dominick J. Angiolillo et al.

JACC-CARDIOVASCULAR INTERVENTIONS (2020)

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Review Cardiac & Cardiovascular Systems

The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y12Inhibitor in Patients After Percutaneous Coronary Intervention A Systematic Review and Meta-Analysis

Michelle L. O'Donoghue et al.

CIRCULATION (2020)

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Article Medicine, General & Internal

Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome The TICO Randomized Clinical Trial

Byeong-Keuk Kim et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2020)

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Article Cardiac & Cardiovascular Systems

Ticagrelor alone vs. ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS

Usman Baber et al.

EUROPEAN HEART JOURNAL (2020)

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Article Cardiac & Cardiovascular Systems

Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD The ASET Pilot Study

Norihiro Kogame et al.

JACC-CARDIOVASCULAR INTERVENTIONS (2020)

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Article Medicine, General & Internal

Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Conventional Clopidogrel Therapy on Ischemic Outcomes After Percutaneous Coronary Intervention: The TAILOR-PCI Randomized Clinical Trial

Naveen L. Pereira et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2020)

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Article Medicine, General & Internal

Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): an open-label, multicentre, non-inferiority randomised trial

Hyo-Soo Kim et al.

LANCET (2020)

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Article Cardiac & Cardiovascular Systems

Antithrombotic Therapy for Atherosclerotic Cardiovascular Disease Risk Mitigation in Patients With Coronary Artery Disease and Diabetes Mellitus

Davide Capodanno et al.

CIRCULATION (2020)

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Article Cardiac & Cardiovascular Systems

Prevention of atherothrombotic events in patients with diabetes mellitus: from antithrombotic therapies to new-generation glucose-lowering drugs

Giuseppe Patti et al.

NATURE REVIEWS CARDIOLOGY (2019)

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Article Cardiac & Cardiovascular Systems

Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk

Philip Urban et al.

EUROPEAN HEART JOURNAL (2019)

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Review Cardiac & Cardiovascular Systems

Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention

Dirk Sibbing et al.

JACC-CARDIOVASCULAR INTERVENTIONS (2019)

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Article Medicine, General & Internal

Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention The SMART-CHOICE Randomized Clinical Trial

Joo-Yong Hahn et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2019)

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Article Medicine, General & Internal

Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI The STOPDAPT-2 Randomized Clinical Trial

Hirotoshi Watanabe et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2019)

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Article Medicine, General & Internal

A Genotype-Guided Strategy for Oral P2Y12 Inhibitors in Primary PCI

Daniel M. F. Claassens et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

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Article Cardiac & Cardiovascular Systems

Final results of the randomised evaluation of short-term dual antiplatelet therapy in patients with acute coronary syndrome treated with a new-generation stent (REDUCE trial)

Giuseppe De Luca et al.

EUROINTERVENTION (2019)

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Article Cardiac & Cardiovascular Systems

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

Borja Ibanez et al.

EUROPEAN HEART JOURNAL (2018)

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Review Pharmacology & Pharmacy

Role of genetic testing in patients undergoing percutaneous coronary intervention

Jae Youn Moon et al.

EXPERT REVIEW OF CLINICAL PHARMACOLOGY (2018)

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Article Cardiac & Cardiovascular Systems

Pharmacodynamic Effects of Switching From Ticagrelor to Clopidogrel in Patients With Coronary Artery Disease Results of the SWAP-4 Study

Francesco Franchi et al.

CIRCULATION (2018)

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Article Medicine, General & Internal

6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial

Joo-Yong Hahn et al.

LANCET (2018)

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Review Cardiac & Cardiovascular Systems

Evolution of Coronary Stent Technology and Implications for Duration of Dual Antiplatelet Therapy

Jae Youn Moon et al.

PROGRESS IN CARDIOVASCULAR DISEASES (2018)

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Article Medicine, General & Internal

Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial

Elvin Kedhi et al.

BMJ-BRITISH MEDICAL JOURNAL (2018)

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Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial

Marco Valgimigli et al.

EUROPEAN HEART JOURNAL (2017)

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Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients

Tullio Palmerini et al.

EUROPEAN HEART JOURNAL (2017)

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Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study

Thomas Cuisset et al.

EUROPEAN HEART JOURNAL (2017)

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Editorial Material Medicine, General & Internal

Dual antiplatelet therapy guided by platelet function testing

Dominick J. Angiolillo

LANCET (2017)

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Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial

Dirk Sibbing et al.

LANCET (2017)

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Article Cardiac & Cardiovascular Systems

Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: the SCOPE registry

Leonardo De Luca et al.

EUROINTERVENTION (2017)

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Pharmacodynamic Comparison of Prasugrel Versus Ticagrelor in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease The OPTIMUS (Optimizing Antiplatelet Therapy in Diabetes Mellitus)-4 Study

Francesco Franchi et al.

CIRCULATION (2016)

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Article Cardiac & Cardiovascular Systems

Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI

Gennaro Giustino et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2016)

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Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial

Guillaume Cayla et al.

LANCET (2016)

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Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry

Usman Baber et al.

CIRCULATION-CARDIOVASCULAR INTERVENTIONS (2015)

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Bleeding and stent thrombosis on P2Y12-inhibitors: collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention

Daniel Aradi et al.

EUROPEAN HEART JOURNAL (2015)

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Body Mass Index and Platelet Reactivity During Dual Antiplatelet Therapy With Clopidogrel or Ticagrelor

Matteo Nardin et al.

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY (2015)

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Impaired Responsiveness to the Platelet P2Y12 Receptor Antagonist Clopidogrel in Patients With Type 2 Diabetes and Coronary Artery Disease

Dominick J. Angiolillo et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2014)

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Article Cardiac & Cardiovascular Systems

Differential prognostic impact of high on-treatment platelet reactivity among patients with acute coronary syndromes versus stable coronary artery disease undergoing percutaneous coronary intervention

Duk-Woo Park et al.

AMERICAN HEART JOURNAL (2013)

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Article Cardiac & Cardiovascular Systems

Platelet Function Profiles in Patients with Diabetes Mellitus

Fabiana Rollini et al.

JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH (2013)

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Reduced-Function CYP2C19 Genotype and Risk of Adverse Clinical Outcomes Among Patients Treated With Clopidogrel Predominantly for PCI A Meta-analysis

Jessica L. Mega et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2010)

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Article Medicine, General & Internal

Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes

Lars Wallentin et al.

NEW ENGLAND JOURNAL OF MEDICINE (2009)

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Article Medicine, General & Internal

Prasugrel versus clopidogrel in patients with acute coronary syndromes

Stephen D. Wiviott et al.

NEW ENGLAND JOURNAL OF MEDICINE (2007)

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