Ticagrelor alone or conventional dual antiplatelet therapy in patients with stable or acute coronary syndromes

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention, but prolonged DAPT increases bleeding risk.
• Ticagrelor monotherapy is an alternative strategy to balance efficacy and safety.
• The GLOBAL LEADERS Adjudication Sub-Study (GLASSY) investigated ticagrelor monotherapy post-DAPT.

Purpose of the Study:

• To evaluate ticagrelor monotherapy after one month of DAPT versus conventional DAPT.
• To assess the effects in patients with and without acute coronary syndrome (ACS).
• To determine net clinical benefit and bleeding risks.

Main Methods:

• A total of 7,685 patients (3,840 ACS, 3,745 stable ischaemic heart disease) were analyzed.
• Co-primary efficacy endpoint: composite of death, myocardial infarction, stroke, or urgent target vessel revascularisation.
• Bleeding events assessed by BARC 3 or 5 criteria.

Main Results:

• At two years, ticagrelor monotherapy showed a non-significant trend towards lower efficacy endpoint rates in ACS patients (7.94% vs 9.68%) and SIHD patients (6.31% vs 7.14%).
• Trends suggested lower bleeding risk with ticagrelor monotherapy in ACS patients (2.27% vs 3.00%) but higher risk in SIHD patients (2.70% vs 1.96%).
• A net clinical benefit endpoint favoured ticagrelor monotherapy in ACS patients but not in SIHD patients.

Conclusions:

• Ticagrelor monotherapy after one month of DAPT provides consistent ischaemic benefits across patient groups.
• Only patients with acute coronary syndrome (ACS) demonstrated a net clinical benefit with this strategy.
• The study identifier is NCT03231059.