# DAPT de-escalatie na ACS: IPD meta-analyse

*geplaatst 2023-04-17 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehac829 · https://hartvaat.nl/2023/04/17/dapt-de-escalatie-na-acs-ipd-meta-analyse/*

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.

## English: Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis.

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.

## Abstract (original, from the publication)

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).

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehac829. Bijgewerkt 2026-07-03T13:29:24Z. 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.