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        A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

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        Author
        Kubica, Jacek
        Adamski, Piotr
        Niezgoda, Piotr
        Kubica, Aldona
        Podhajski, Przemysław
        Barańska, Malwina
        Umińska, Julia M.
        Pietrzykowski, Łukasz
        Ostrowska, Małgorzata
        Siller-Matula, Jolanta M.
        Badarienė, Jolita
        Bartuś, Stanisław
        Budaj, Andrzej
        Dobrzycki, Sławomir
        Fidor, Łukasz
        Gąsior, Mariusz
        Gessek, Jacek
        Gierlotka, Marek
        Gil, Robert
        Gorący, Jarosław
        Grzelakowski, Paweł
        Hajdukiewicz, Tomasz
        Jaguszewski, Miłosz
        Janion, Marianna
        Kasprzak, Jarosław
        Kern, Adam
        Klecha, Artur
        Kleinrok, Andrzej
        Kochman, Wacław
        Krakowiak, Bartosz
        Legutko, Jacek
        Lesiak, Maciej
        Nosal, Marcin
        Piotrowski, Grzegorz
        Przybylski, Andrzej
        Roleder, Tomasz
        Skonieczny, Grzegorz
        Sobieszek, Grzegorz
        Tycińska, Agnieszka
        Wojciechowski, Dariusz
        Wojakowski, Wojciech
        Wójcik, Jarosław
        Zielińska, Marzenna
        Żurakowski, Aleksander
        Specchia, Giuseppe
        Gorog, Diana A.
        Navarese, Eliano P.
        Attention
        2299/25305
        Abstract
        The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.
        Publication date
        2021-06-02
        Published in
        Cardiology Journal
        Published version
        https://doi.org/10.5603/CJ.a2021.0056
        License
        http://creativecommons.org/licenses/by/4.0/
        Other links
        http://hdl.handle.net/2299/25305
        Relations
        School of Life and Medical Sciences
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