Escalation and de-escalation of double antiplatelet therapy in patients with acute coronary syndrome
The review deals with the problems of escalation and de-escalation of double antiplatelet therapy in patients with ACS. Differences in the pharmacology of P2Y12 receptor inhibitors with respect to their binding mechanism, half-life, and onset and duration of action are important factors that influence drug interactions during the switching from one drug to another. Currently, the transition from clopidogrel to ticagrelor is the only one investigated between P2Y12 inhibitors that has been evaluated with a focus on clinical endpoints, although PLATO study was not specifically planned to assess the safety and efficacy of the switching from clopidogrel to ticagrelor. The article also provides data from registers and non-randomized trials aimed at the evaluation of clinical endpoints.