De-escalation reduces bleeding risks in ACS. There are different strategies that can be described as de-escalation including guided and unguided. What is the current evidence regarding the different de-escalation strategies? And which patients are candidates for de-escalation strategies? VDO from expert (Prof.Sibbing)
HOST-EXAM Extended study: Clopidogrel monotherapy had lower discontinuation rate (8% vs. 13.5%), reduced risk of death, MI, stroke, ACS readmission, and bleeding. Long-term clopidogrel use preferred for CAD secondary prevention.
Limited comparison of baseline characteristics due to lack of age stratification in many studies. Higher risk of bleeding events with prasugrel/ticagrelor vs clopidogrel. No difference in efficacy endpoint rates. Results unchanged after excluding non-RCTs, high statistical heterogeneity in endpoint analysis.