Antiplatelet therapy de-escalation a promising strategy for East Asian patients undergoing PCI

De-escalation of antiplatelet therapy appears to yield more favourable outcomes compared with standard dual antiplatelet therapy (DAPT) in East Asian patients with acute coronary syndrome (ACS) who are undergoing percutaneous coronary intervention (PCI), as shown in a study.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials wherein de-escalation with DAPT was assessed in ACS patients scheduled to undergo PCI. Outcomes included major adverse cardiovascular events (MACE), ischaemic events, major bleeding, minor bleeding, and any bleeding.

The meta-analysis included eight randomized controlled trials from 539 potentially relevant publications with a total of 15,744 East Asian patients. Pooled data showed that compared with standard DAPT, de-escalation was associated with a significantly lower MACE (hazard ratio [HR], 0.82, 95 percent confidence interval [CI], 0.69–0.98) and major bleeding event (HR, 0.62, 95 percent CI, 0.46–0.82) without heterogeneity.

Subgroup analysis was also performed based on treatment strategy: DAPT followed by P2Y12 inhibitor monotherapy and a reduced dose of P2Y12 inhibitors. Results showed that DAPT followed by P2Y12 inhibitor monotherapy was associated with a 48-percent lower risk of major bleeding events compared with standard DAPT (HR, 0.52, 95 percent CI, 0.27–1.00).

On the other hand, no significant difference was seen between reduced dose of P2Y12 inhibitors and standard DAPT (HR, 0.99, 95 percent CI, 0.55–1.76).

The findings indicate that a de-escalation strategy of DAPT followed by P2Y12 inhibitor monotherapy may be a safer and equally effective approach relative to standard DAPT in East Asian patients with ACS undergoing PCI.