{"id":"3f5cb669e363","type":"article","url":"https://hartvaat.nl/2021/08/24/de-escalatie-van-dapt-bij-acs-jacc-review/","title":"De-escalatie van DAPT bij ACS: JACC review","title_en":"De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.06.012","source_url":"https://doi.org/10.1016/j.jacc.2021.06.012","authors":["Satoshi Shoji","Toshiki Kuno","Tomohiro Fujisaki","Hisato Takagi","Alexandros Briasoulis","Pierre Deharo","Thomas Cuisset","Azeem Latib","Shun Kohsaka"],"significance":7,"published":"2021-08-24","source_date":"2021-08-24","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This JACC review comprehensively summarized all available evidence on DAPT de-escalation strategies after ACS, including guided (pharmacogenomic/pharmacodynamic), unguided, dose-reduction, and early aspirin discontinuation approaches.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JACC review over de-escalatiestrategieën voor DAPT na ACS. Integreert alle beschikbare evidence.","abstract_original":"BACKGROUND: Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent P2Y12 inhibitors has become a cornerstone of acute coronary syndrome (ACS) management. Recent randomized controlled trials (RCTs) have investigated DAPT de-escalation to decrease the risk of bleeding outcomes. OBJECTIVES: The aim of this study was to compare the efficacy and safety outcomes of various DAPT strategies in patients with ACS, including de-escalation from a potent P2Y12 inhibitor to clopidogrel or low-dose prasugrel. METHODS: MEDLINE and EMBASE were searched through January 2021 for RCTs investigating the efficacy and safety of DAPT in patients with ACS, and a network meta-analysis was conducted. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, and stroke. The primary bleeding outcome was trial-defined major or minor bleeding. RESULTS: Our search identified 15 eligible RCTs, including 55,798 patients with ACS. De-escalation therapy was associated with reduced risk of primary bleeding outcomes (HR: 0.48 [95% CI: 0.30-0.77] vs clopidogrel; HR: 0.32 [95% CI: 0.20-0.52] vs ticagrelor; HR: 0.36 [95% CI: 0.24-0.55] vs standard-dose prasugrel; and HR: 0.40 [95% CI: 0.22-0.75] vs low-dose prasugrel) without negatively affecting primary efficacy outcomes. There were no significant differences in ischemic or bleeding outcomes between de-escalation to clopidogrel or low-dose prasugrel. CONCLUSIONS: Compared with other established uses of DAPT, de-escalation was the most effective strategy for ACS treatment, resulting in fewer bleeding events without increasing ischemic events."}