De-Escalation of Treatment With Oral P2Y12 Receptor Inhibitors: Current Status and Perspectives.

Abstract

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.

• Authors: Dimitrios Alexopoulos, Ioannis Lianos, Panagiotis Vlachakis, Danai Sfantou, Vassiliki-Maria Dragona, Charalambos Varlamos
• Journal: Journal of cardiovascular pharmacology and therapeutics (J Cardiovasc Pharmacol Ther) Vol. 24 Issue 4 Pg. 304-314 (07 2019) ISSN: 1940-4034 [Electronic] United States
• PMID: 30722685 (Publication Type: Journal Article, Review)

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists

Topics

• Acute Coronary Syndrome (diagnosis, therapy)
• Administration, Oral
• Animals
• Clinical Decision-Making
• Coronary Thrombosis (etiology, prevention & control)
• Drug Administration Schedule
• Drug Substitution
• Hemorrhage (chemically induced)
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Risk Factors
• Treatment Outcome