# De-escalatie van DAPT bij ACS: JACC review

*geplaatst 2021-08-24 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2021.06.012 · https://hartvaat.nl/2021/08/24/de-escalatie-van-dapt-bij-acs-jacc-review/*

JACC review over de-escalatiestrategieën voor DAPT na ACS. Integreert alle beschikbare evidence.

## English: De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes.

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.

## Abstract (original, from the publication)

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.

Auteurs: Satoshi Shoji, Toshiki Kuno, Tomohiro Fujisaki, Hisato Takagi, Alexandros Briasoulis, Pierre Deharo, Thomas Cuisset, Azeem Latib, Shun Kohsaka

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2021.06.012. Bijgewerkt 2026-07-03T13:28:28Z. 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.