{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:23:25Z","timestamp":1779254605989,"version":"3.51.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"},{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002336","name":"Daiichi Sankyo Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Platelet function testing (PFT)-guided de-escalation of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been shown to reduce bleeding risk without increasing ischaemic events. Patients with high atherothrombotic risk (ATR) remain a challenging subgroup for such strategies. This study evaluated the safety and efficacy of early PFT-guided DAPT de-escalation according to ATR status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In the TROPICAL-ACS trial, 2610 ACS patients were randomized to standard 12-month prasugrel therapy or PFT-guided DAPT de-escalation. For this post hoc analysis, patients were stratified by ATR. High ATR was defined as age \u2265 65 years, polyvascular disease, or \u22652 risk factors (diabetes, smoking, or renal dysfunction). Hazard ratios (HRs) for clinical endpoints were derived using multistate Cox regression. High-ATR patients (n = 990) had a higher incidence of the primary net clinical benefit endpoint\u2014composite of cardiovascular death, myocardial infarction, stroke, or Bleeding Academic Research Consortium 2\u20135 bleeding\u2014compared with low-ATR patients (n = 1620) (11.0% vs. 6.7%; HR 1.67, 95% confidence interval 1.28\u20132.18; P &amp;lt; 0.001). Platelet function testing-guided de-escalation showed no significant interaction by ATR status for the primary endpoint [high ATR: 10.5% vs. 11.5%, HR 0.90 (0.61\u20131.32), P = 0.586; low ATR: 5.6% vs. 7.7%, HR 0.71 (0.48\u20131.04), P = 0.082; Pinteraction = 0.394] or ischaemic events [high ATR: 3.7% vs. 4.4%, HR 0.83 (0.44\u20131.56); low ATR: 1.8% vs. 2.6%, HR 0.68 (0.35\u20131.34); Pinteraction = 0.666].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early PFT-guided de-escalation from prasugrel to clopidogrel was safe across atherothrombotic risk categories, supporting individualized DAPT optimization in ACS patients with both low and high ischaemic risk.<\/jats:p>\n                  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,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dietmar","family":"Trenk","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg-Bad Krozingen , S\u00fcdring 15, 79189 Bad Krozingen ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Cardiology, LMU M\u00fcnchen , Marchioninistra\u00dfe 15, Munich 81377 ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"L\u00f6w","sequence":"additional","affiliation":[{"name":"Department of Cardiology, LMU M\u00fcnchen , Marchioninistra\u00dfe 15, Munich 81377 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Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1695-3378","authenticated-orcid":false,"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"Austrian Heart Foundation and Ludwig Boltzmann Institute for Cardiovascular Research , Vienna ,","place":["Austria"]},{"name":"Medical Private University Burgenland (MPUB) , Pinkafeld\/Oberwart ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-3986","authenticated-orcid":false,"given":"Steffen","family":"Massberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, LMU M\u00fcnchen , Marchioninistra\u00dfe 15, Munich 81377 ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0698-2696","authenticated-orcid":false,"given":"Dirk","family":"Sibbing","sequence":"additional","affiliation":[{"name":"Department of Cardiology, LMU M\u00fcnchen , Marchioninistra\u00dfe 15, Munich 81377 ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich ,","place":["Germany"]},{"name":"Private Clinic Lauterbacher M\u00fchle at the Ostersee , Seeshaupt ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5993-0339","authenticated-orcid":false,"given":"Konstantinos D","family":"Rizas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, LMU M\u00fcnchen , Marchioninistra\u00dfe 15, Munich 81377 ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance 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