Davide Capodanno; Roxana Mehran; Mitchell W. Krucoff; Usman Baber; Deepak L. Bhatt; Piera Capranzano; Jean-Philippe Collet; Thomas Cuisset; Giuseppe De Luca; Leonardo De Luca; Andrew Farb; Francesco Franchi; C. Michael Gibson; Joo-Yong Hahn; Myeong-Ki Hong; Stefan James; Adnan Kastrati; Takeshi Kimura; Pedro A. Lemos; Renato D. Lopes; Adrian Magee; Ryosuke Matsumura; Shuichi Mochizuki; Michelle L. O’Donoghue; Naveen L. Pereira; Sunil V. Rao; Fabiana Rollini; Yuko Shirai; Dirk Sibbing; Peter C. Smits; P. Gabriel Steg; Robert F. Storey; Jurrien ten Berg; Marco Valgimigli; Pascal Vranckx; Hirotoshi Watanabe; Stephan Windecker; Patrick W. Serruys; Robert W. Yeh; Marie-Claude Morice; Dominick J. Angiolillo.
DOI: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064473
Abstract
Antiplatelet therapy is the mainstay of pharmacologic treatment to prevent thrombotic or ischemic events in patients with coronary artery disease treated with percutaneous coronary intervention and those treated medically for an acute coronary syndrome. The use of antiplatelet therapy comes at the expense of an increased risk of bleeding complications. Defining the optimal intensity of platelet inhibition according to the clinical presentation of atherosclerotic cardiovascular disease and individual patient factors is a clinical challenge. Modulation of antiplatelet therapy is a medical action that is frequently performed to balance the risk of thrombotic or ischemic events and the risk of bleeding. This aim may be achieved by reducing (ie, de-escalation) or increasing (ie, escalation) the intensity of platelet inhibition by changing the type, dose, or number of antiplatelet drugs. Because de-escalation or escalation can be achieved in different ways, with a number of emerging approaches, confusion arises with terminologies that are often used interchangeably. To address this issue, this Academic Research Consortium collaboration provides an overview and definitions of different strategies of antiplatelet therapy modulation for patients with coronary artery disease, including but not limited to those undergoing percutaneous coronary intervention, and consensus statements on standardized definitions.
