In this Consensus Statement, we summarize the evidence base for these treatment approaches, provide guidance on the assessment of ischaemic and bleeding risks, and provide consensus statements from an international panel of experts to help clinicians to optimize these DAPT approaches for individual patients to improve outcomes.Īntiplatelet therapy is central to the management of acute coronary syndromes (ACS) in patients undergoing percutaneous coronary intervention (PCI). However, these two strategies have not yet been compared in a head-to-head clinical trial. Abbreviation of DAPT duration after 1–6 months, followed by monotherapy with aspirin or a P2Y 12 inhibitor, reduces bleeding without an increase in ischaemic events in patients at high bleeding risk, particularly those without high ischaemic risk. De-escalation of DAPT intensity can reduce bleeding without increasing ischaemic events and can be guided by platelet function testing or genotyping. Either strategy requires assessment of the ischaemic and bleeding risks of each individual. Strategies to reduce bleeding include de-escalation of DAPT intensity (downgrading from potent P2Y 12 inhibitor at conventional doses to either clopidogrel or reduced-dose prasugrel) or abbreviation of DAPT duration. Although this approach reduces ischaemic risk, patients are exposed to a substantial risk of bleeding. Lip ORCID: /0000-0002-7566-1626 29, 30, 31Ĭonventional dual antiplatelet therapy (DAPT) for patients with acute coronary syndromes undergoing percutaneous coronary intervention comprises aspirin with a potent P2Y purinoceptor 12 (P2Y 12) inhibitor (prasugrel or ticagrelor) for 12 months. De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis
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