Gragnano Felice, Capolongo Antonio, Terracciano Fabrizia, Gargiulo Giuseppe, Cesaro Arturo, Moscarella Elisabetta, De Sio Vincenzo, Patti Giuseppe, Porto Italo, Esposito Giovanni, Calabrò Paolo
Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "Luigi Vanvitelli", Napoli - Divisione di Cardiologia, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta.
Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli.
G Ital Cardiol (Rome). 2023 Feb;24(2):99-109. doi: 10.1714/3963.39417.
Dual antiplatelet therapy (DAPT) is a cornerstone in the management of patients with acute coronary syndrome (ACS) and/or undergoing percutaneous coronary intervention (PCI). The use of intensified or prolonged antithrombotic regimens is invariably associated with a reduction in ischemic risk yet an increase in the risk of bleeding complications. The selection of the optimal antiplatelet therapy in each individual patient remains therefore crucial. In recent years, novel approaches alternative to the conventional DAPT and based on the escalation or de-escalation of P2Y12 antagonists have been proposed. These strategies, chosen according to clinical features, genetic factors, and platelet function, have been developed to optimize and individualize the treatment of patients with coronary artery disease and improve their prognosis. In this review, we summarize recent evidence about escalation and de-escalation strategies (guided and unguided), and discuss the utility of genetic and platelet function tests in patients with ACS and/or undergoing PCI.
双联抗血小板治疗（DAPT）是急性冠状动脉综合征（ACS）患者管理和/或接受经皮冠状动脉介入治疗（PCI）的基石。强化或延长抗血栓治疗方案的使用总是与缺血风险降低相关，但出血并发症风险增加。因此，为每位患者选择最佳抗血小板治疗仍然至关重要。近年来，已经提出了替代传统DAPT的新方法，这些方法基于P2Y12拮抗剂的强化或降级。这些根据临床特征、遗传因素和血小板功能选择的策略，旨在优化和个体化冠状动脉疾病患者的治疗并改善其预后。在本综述中，我们总结了关于强化和降级策略（有指导和无指导）的最新证据，并讨论了基因和血小板功能检测在ACS患者和/或接受PCI患者中的应用。
