Kim HS, Kang J, Hwang D, et al. - Given that in patients with acute coronary syndrome receiving percutaneous coronary intervention (PCI), a potent P2Y12 inhibitor-based dual antiplatelet therapy is advised for up to 1 year, and that the greatest advantage of the potent agent is during the early phase, whereas the risk of excess bleeding remains in the chronic maintenance phase, so, a prasugrel-based dose de-escalation therapy was tested in terms of safety and efficacy in this randomised, open-label, multicentre, non-inferiority trial (HOST-REDUCE-POLYTECH-ACS). Patients with acute coronary syndrome undergoing PCI were enrolled. Experts randomized (1:1) patients meeting the core indication for prasugrel to the de-escalation group or conventional group. Following 1 month of therapy with 10 mg prasugrel plus 100 mg aspirin daily, 5 mg prasugrel was administered to the de-escalation group, while the conventional group continued to receive 10 mg. Net adverse clinical events at 1 year was the primary endpoint. According to the findings, reduced risk of net clinical outcomes up to 1 year, predominantly driven by an attenuation in bleeding without an increase in ischaemia, was conferred by a prasugrel-based dose de-escalation strategy from 1 month post-PCI in east Asian patients.