Outcomes of appropriate versus inappropriate de-escalation of p2y12 inhibitor therapy post percutaneous coronary intervention: a retrospective cohort study.

Current guidelines recommend ticagrelor or prasugrel as first-line agents for patients with acute coronary syndromes (ACS). While de-escalation from ticagrelor or prasugrel to clopidogrel is common practice, this may be considered “inappropriate” when a change between potent agents is an option. This practice may put patients at risk of ischemic complications. We sought to determine, in a large contemporary cohort after ACS: i) the incidence of de-escalation, ii) the “appropriateness” of the rationale and iii) quantify potential patients who may benefit with a lateral switch in therapy in lieu of de-escalation.