Personalized antiplatelet therapy in a post-PCI patient with high bleeding risk
Mansurova J. Kassymova A. Kozhabayeva A. Karazhanova L.
March 2025Pharmamed Mado Ltd
Signa Vitae
2025#21Issue 3114 - 119 pp.
Background: Therapeutic de-escalation involving P2Y12 receptor inhibitors, such as transitioning from prasugrel or ticagrelor to clopidogrel or reducing the dose of prasugrel or ticagrelor, has been proposed as an alternative strategy for dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS). This approach is particularly relevant for patients at high bleeding risk who are unsuitable for potent P2Y12 receptor inhibitors. However, de-escalation within the first 30 days following the ACS index event is associated with an increased risk of ischemic events and is generally not recommended. Case: We present a clinical case of a post-percutaneous coronary intervention (PCI) patient with a high risk of bleeding who underwent de-escalation of DAPT. The approach involved reducing the dose of ticagrelor, a potent P2Y12 receptor inhibitor, guided by platelet function testing and genetic analysis. A transition to clopidogrel, a less potent P2Y12 receptor inhibitor, was not feasible due to prior stent thrombosis while the patient was on clopidogrel. Conclusions: This case highlights the importance of individualized antithrombotic strategies in high-risk patients. Prospective evaluation of de-escalation strategies using platelet function testing or genetic analysis is recommended to optimize therapy while minimizing both bleeding and ischemic risks.
Bleeding , De-escalation , P2Y12 receptor inhibitor , Percutaneous coronary intervention , Residual platelet reactivity
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Semey Medical University, AR, Semey, 071400, Kazakhstan
Semey Medical University
10 лет помогаем публиковать статьи Международный издатель
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