Prasugrel-based economical antiplatelet de-escalation after percutaneous coronary intervention in rural India (PEADPCI)

Background: Antiplatelet therapy plays a key role in the post-percutaneous coronary intervention (PCI) period. Current recommendations suggest dual antiplatelet therapy (DAPT) for at least 12 months for patients with acute coronary syndrome (ACS) undergoing PCI. We evaluated the clinical outcomes of switching from prasugrel to the more economical clopidogrel after 3 months. Methods: This observational prospective study was conducted at a tertiary care hospital between February 2021 and January 2024. Patients with ACS aged >18 years who were receiving prasugrel as their second antiplatelet agent were included. Results: Overall, 842 patients were included. Most patients were male (73.43%) with a mean age of 56.64 years. Hypertension was observed in 46.79% of patients. Acute anterior wall myocardial infarction (25.29%) was the most common ACS presentation. After switching to clopidogrel, 0.83% of patients ( n = 7) were lost to follow-up. Myocardial infarction occurred in 1.3% of patients ( n = 11), while both stent thrombosis and target lesion failure were observed in 1.06% ( n = 9 each), and nonfatal ischemic stroke in 0.35% ( n = 3). Target vessel revascularization was required in 1.18% ( n = 10). Three deaths were recorded, and two patients experienced major bleeding. Conclusion: In patients with ACS who underwent PCI, switching from prasugrel to clopidogrel after 3 months did not significantly affect clinical outcomes. This strategy offers an economical DAPT option for patients with lower socioeconomic backgrounds.