Antiplatelet De-Escalation After Percutaneous Coronary Intervention: Bleeding Reduction Without Ischaemic Cost
DOI:
https://doi.org/10.5281/zenodo.22497833Abstract
Potent P2Y12 inhibition with ticagrelor or prasugrel, added to aspirin after percutaneous coronary intervention (PCI) for
acute coronary syndrome (ACS), lowers ischaemic risk more than clopidogrel does, and that advantage is exactly why both
drugs became the guideline default. The same potency that blocks a future thrombotic event also blocks the platelet
response needed to stop a bleed, and the bleeding cost is front-loaded: it is highest in the weeks after PCI, precisely
when the ischaemic benefit of potent inhibition is thought to matter least, because the culprit lesion has already been treated
and the residual thrombotic risk is falling.
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