Assessment of the efficacy and safety of the abatement of antiplatelet therapy in patients with acute coronary syndrome

Abstract

This dissertation focuses on the assessment of the efficacy and safety of the abatement of antiplatelet therapy in patients with acute coronary syndrome (ACS). The aim of this thesis was to identify cardio-protective strategies against myocardial ischemia–reperfusion injury, evaluate the impact of dual antiplatelet therapy (DAPT) abatement strategies in patients with percutaneous coronary intervention (PCI) and assess the effectiveness of precision medicine approaches in individualizing P2Y12 de-escalation strategies, such as platelet function testing (PFT) guidance, genetic testing guidance, and uniform de-escalation, for ACS patients undergoing PCI. Three distinct studies were conducted, the initial investigation is based on a literature review, the second study entails a comprehensive meta-analysis of RCTs and the third study is a comprehensive literature review of clinical trials. These studies suggest that: beta-blockers, antiplatelet therapy and glycoprotein IIb/IIIa inhibitors show improvements in myocardial ischemia-reperfusion injury, de-escalation of antiplatelet therapy can reduce bleeding risk without compromising the risk of MACE, mostly monotherapy strategy, and the use of uniform unguided de-escalation is the most effective strategy in reducing bleeding events while maintaining efficacy. However, it is important to consider individual patient factors such as bleeding risk, thromboembolic risk, and patient comorbidities to select the optimal approach for DAPT abatement.