De-escalation strategies in patients with acute coronary syndrome: a step towards precision medicine.

Autor: Gragnano F; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy., Capolongo A; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy., Terracciano F; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., De Sio V; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Maddaluna P; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Fimiani F; Unit of Inherited and Rare Cardiovascular Diseases, AORN Dei Colli 'V. Monaldi', Naples, Italy., Moscarella E; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Cesaro A; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Montone RA; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Bianco R; Department of Public Health, University of Naples Federico II, Naples, Italy., Lisi D; UOC Risk Management, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Mensorio MM; UOC Organizzazione E Programmazione Dei Servizi Ospedalieri E Sanitari, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Annecchiarico A; Direzione Sanitaria, AORN 'Sant'anna E San Sebastiano', Caserta, Italy., Calabrò P; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.; Division of Cardiology, AORN 'Sant'anna E San Sebastiano', Caserta, Italy.
Jazyk: angličtina
Zdroj: Expert review of cardiovascular therapy [Expert Rev Cardiovasc Ther] 2023 Jul-Dec; Vol. 21 (7), pp. 545-551. Date of Electronic Publication: 2023 Jun 05.
DOI: 10.1080/14779072.2023.2221851
Abstrakt: Introduction: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 inhibitor is a cornerstone in the treatment of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Current international guidelines recommend the use of 12 months of DAPT with newer P2Y 12 inhibitors (i.e. ticagrelor or prasugrel) as first-line therapy in this setting. However, intense and prolonged DAPT regimens are associated with an increased risk of bleeding, with relevant prognostic implications. Recently, a strategy of de-escalation of P2Y 12 inhibitors has been proposed as an alternative to conventional DAPT to mitigate the risk of bleeding while preserving ischemic protection after ACS.
Areas Covered: In this review, we summarize the available evidence on guided and unguided strategies for P2Y 12 inhibitor de-escalation in patients with ACS undergoing PCI.
Expert Opinion: Among patients with ACS, guided and unguided de-escalation strategies are safe and effective for secondary cardiovascular prevention. Although the implementation of genetic and platelet function tests is of interest for treatment personalization, the routine use of guided de-escalation strategies seems impractical. In this context, unguided de-escalation approaches appear more attractive, convenient, and suitable for contemporary practice.
Databáze: MEDLINE
Externí odkaz: