Antiplatelet therapy de-escalation in a patient after percutaneous coronary intervention with a high risk of bleeding

According to recommendations of ESC 2020-year, de-escalation therapy with a P2Y12 receptor inhibitor (transition from prasugrel or ticagrelor clopidogrel) It can be considered as an alternative strategy dual antiplatelet (DAPT) for patients acute coronary syndrome (ACS) who are unsuitable the use strong platelet inhibitor. De-escalation performed based on individual clinical evaluation under supervision function testing CYP2C19 genotyping, depending patient’s risk profile and availability appropriate diagnostic methods. The optimal dosage inhibitors, such is not entirely clear especially difficult define Asian nationality. article describes case de-escalation, particularly dose reduction potent in patient after percutaneous intervention (PCI) high bleeding determination genetic testing. A 47-year-old Kazakh nationality was hospitalized gastrointestinal bleeding. Given type 3 by BARC (Bleeding Academic Research Consortium) associated DAPT, it decided apply de-escalate control (PFT) In this case, replacement weak clopidogrel possible appeared carrier CYP2C19*2 polymorphism contributing loss cytochrome P-450(CYP) enzyme.