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Dual antiplatelet therapy escalation and de-escalation.
Antonio Greco1, Giacinto Di Leo1, Simone Finocchiaro1
1Azienda Ospedaliero-Universitaria Policlinico 'G. Rodolico-San Marco', University of Catania, Via Santa Sofia, 78, Catania 95123, Italy.
European Heart Journal. Acute Cardiovascular Care
|January 5, 2026
Summary
Dual antiplatelet therapy (DAPT) de-escalation reduces bleeding risk after percutaneous coronary intervention without compromising ischemic protection in select patients. This review summarizes evidence for DAPT modulation strategies.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is crucial for secondary prevention post-percutaneous coronary intervention (PCI).
- Balancing ischemic protection against bleeding risk with DAPT remains a clinical challenge.
- DAPT modulation strategies, particularly de-escalation, are gaining traction.
Purpose of the Study:
- To review evidence supporting DAPT modulation strategies.
- To critically evaluate randomized trials on DAPT de-escalation and escalation.
- To highlight current research and ongoing studies in DAPT optimization.
Main Methods:
- Systematic review of randomized controlled trials.
- Analysis of evidence for DAPT de-escalation (dose reduction, drug discontinuation, switching agents).
- Assessment of evidence for DAPT escalation strategies.
Main Results:
- DAPT de-escalation significantly reduces bleeding events without increasing ischemic events in selected patients.
- Escalation strategies have limited evidence and guideline support.
- Most contemporary patients undergoing PCI are at higher risk for bleeding than thrombosis.
Conclusions:
- DAPT de-escalation is a viable strategy to mitigate bleeding risk post-PCI.
- Further research is needed to refine DAPT escalation strategies.
- Personalized DAPT regimens are essential for optimal patient outcomes.
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