Farag Mohamed, Jeyalan Visvesh, Ferreiro Jose Luis, Jeong Young-Hoon, Geisler Tobias, Gorog Diana A
Department of Cardiology, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom.
Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.
Front Cardiovasc Med. 2022 Oct 20;9:1018649. doi: 10.3389/fcvm.2022.1018649. eCollection 2022.
Current guidelines for patients with acute coronary syndrome (ACS) recommend dual antiplatelet therapy (DAPT) for 12 months. Since bleeding is the main Achilles' heel of DAPT, in recent years several randomized controlled trials have evaluated the safety and efficacy of de-escalation of DAPT with respect to ischaemic and bleeding endpoints. These trials can be broadly divided into studies evaluating a shorter duration of DAPT, and those studies in which DAPT that includes a potent P2Y inhibitor, such as prasugrel or ticagrelor, is compared to less intense DAPT, mainly clopidogrel or reduced-dose prasugrel. We sought to evaluate the studies assessing de-escalation of DAPT in patients with ACS undergoing PCI. We review the studies evaluating the strategies of de-escalation of DAPT intensity and those evaluating a strategy of de-escalation of DAPT duration in ACS patients undergoing PCI. We summarize the limitations of studies to date, gaps in evidence and make recommendations for future studies.
急性冠状动脉综合征（ACS）患者的现行指南推荐进行为期12个月的双联抗血小板治疗（DAPT）。由于出血是DAPT的主要薄弱环节，近年来多项随机对照试验评估了DAPT降阶梯治疗在缺血和出血终点方面的安全性和有效性。这些试验大致可分为评估较短DAPT疗程的研究，以及将包含强效P2Y抑制剂（如普拉格雷或替格瑞洛）的DAPT与强度较低的DAPT（主要是氯吡格雷或低剂量普拉格雷）进行比较的研究。我们试图评估评估接受PCI的ACS患者DAPT降阶梯治疗的研究。我们回顾了评估DAPT强度降阶梯策略以及评估接受PCI的ACS患者DAPT疗程降阶梯策略的研究。我们总结了迄今研究的局限性、证据空白，并对未来研究提出建议。
