{"id":"52e750db0ae4","type":"article","url":"https://hartvaat.nl/2023/04/17/dapt-de-escalatie-na-acs-ipd-meta-analyse/","title":"DAPT de-escalatie na ACS: IPD meta-analyse","title_en":"Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac829","source_url":"https://doi.org/10.1093/eurheartj/ehac829","authors":["Jeehoon Kang","Konstantinos D Rizas","Kyung Woo Park","Jaewook Chung","Wout van den Broek","Daniel M F Claassens","Eun Ho Choo","Dániel Aradi","Steffen Massberg","Doyeon Hwang","Jung-Kyu Han","Han-Mo Yang","Hyun-Jae Kang","Kiyuk Chang","Jur M Ten Berg","Dirk Sibbing","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":8,"published":"2023-04-17","source_date":"2023-04-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that de-escalation from potent P2Y12 inhibitors to clopidogrel after the acute phase of ACS safely reduces bleeding without increasing ischemic events. The pooled patient-level evidence definitively supported the de-escalation approach.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","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":"Individuele-patiëntdata meta-analyse bevestigde dat de-escalatie van DAPT (van prasugrel/ticagrelor naar clopidogrel) na ACS veilig is met minder bloedingen zonder toename van ischemische events. Dit personaliseert de antiplaatjesbehandeling na de acute fase.","abstract_original":"AIMS: Dual-antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is the standard treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). De-escalation of the potent P2Y12 inhibtor is an appealing concept to balance the ischaemic and bleeding risks after PCI. An individual patient data meta-analysis was performed to compare de-escalation versus standard DAPT in patients with ACS. METHODS AND RESULTS: Electronic databases, including PubMed, Embase, and the Cochrane database, were searched to identify randomised clinical trials (RCTs) comparing the de-escalation strategy with the standard DAPT after PCI in patients with ACS. Individual patient-level data were collected from the relevant trials. The co-primary endpoints of interest were the ischaemic composite endpoint (a composite of cardiac death, myocardial infarction, and cerebrovascular events) and bleeding endpoint (any bleeding) at 1-year post-PCI. Four RCTs (the TROPICAL-ACS, POPular Genetics, HOST-REDUCE-POLYTECH-ACS, and TALOS-AMI trials) including 10 133 patients were analysed. The ischaemic endpoint was significantly lower in the patients assigned to the de-escalation strategy than in those assigned to the standard strategy (2.3% vs. 3.0%, hazard ratio [HR] 0.761, 95% confidence interval [CI] 0.597-0.972, log rank P = 0.029). Bleeding was also significantly lower in the de-escalation strategy group (6.5% vs. 9.1%, HR 0.701, 95% CI 0.606-0.811, log rank P < 0.001). No significant intergroup differences were observed in terms of all-cause death and major bleeding events. Subgroup analyses revealed that compared to guided de-escalation, unguided de-escalation had a significantly larger impact on bleeding endpoint reduction (P for interaction = 0.007); no intergroup differences were observed for the ischaemic endpoints. CONCLUSION: In this individual patient data meta-analysis, DAPT-based de-escalation was associated with both decreased ischaemic and bleeding endpoints. Reduction in bleeding endpoints was more prominent for the unguided than the guided de-escalation strategy. STUDY REGISTRATION NUMBER: This study was registered in the PROSPERO (ID: CRD42021245477)."}