萝莉社

People are considered for participation in this trial when. they are taking two blood-thinning medications, which include baby aspirin plus either Prasugrel (Effient) or Ticagrelor (Brilinta). These blood-thinning medications prevent blood cells, called platelets, from sticking together, which helps to prevent clots and heart attacks. While these medications are effective at preventing stents from clotting, they also increase the risk of bleeding. To reduce the risk of bleeding while still protecting the heart, doctors sometimes use a strategy called “de-escalation” of blood thinning medication. This involves either continuing to take the stronger blood thinner (Prasugrel or Ticagrelor) for the first month after the stent is placed and stopping aspirin or switching to a less potent blood thinner called Clopidogrel (Plavix®) while maintaining aspirin. Research shows that deescalation can lower the risk of bleeding without increasing the risk of stent clotting. The approach towards de-escalation of blood thinning medications can be done in two ways: guided by laboratory tests or unguided. Both methods are commonly used and recommended by cardiology guidelines. However, no studies have considered how genetics and other clinical factors might guide the switching of medications. This study aims to use genetics and other clinical factors by means of a scoring system called ABCD-GENE (Age, Body Mass Index, Chronic Kidney Disease, Diabetes Mellitus, and Genotyping) to better guide de-escalation of blood-thinning medications for each individual.

Inclusion criteria:

1. Patients who have undergone PCI and are on maintenance treatment with DAPT, composed of low-dose aspirin (81mg qd) with either prasugrel (10 mg qd) or ticagrelor (90 mg bid). In particular, patients who underwent PCI in the setting of an acute coronary syndrome will be eligible for randomization after ≥90 days post-PCI, while patients who underwent PCI in the setting of a chronic coronary syndrome ≥30 days post-PCI.
2. Age >18 years old
3. Provide written informed consent.

Exclusion criteria:

1. Prior history of stent thrombosis
2. PCI within 30 days
3. On treatment with any oral anticoagulant (vitamin K antagonists, dabigatran, rivaroxaban, apixaban, edoxaban) or chronic low-molecular-weight heparin (at venous thrombosis treatment, not for prophylaxis)
4. Hemodynamic instability
5. Hypersensitivity to Aspirin, Clopidogrel[SL1] , Ticagrelor or Prasugrel
6. Known hematologic malignancies or thrombocytopenia (platelet count <80x106/mL)
7. Known hemoglobinopathies or anemia (hemoglobin <9 g/dL)
8. Pregnant and breastfeeding women [women of childbearing age must use reliable birth control (i.e., oral contraceptives) while participating in the study]