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Long-term monotherapy with ticagrelor after coronary stenting: the GLOBAL LEADERS study
Antonio Greco1, Davide Capodanno1
1CAST, A.O.U. "Policlinico-Vittorio Emanuele", P.O. Rodolico, Catania, Italy.
Insights
Dual antiplatelet therapy after coronary interventions increases bleeding risk. The GLOBAL LEADERS trial found ticagrelor monotherapy not superior to dual therapy, but opens doors for safer antithrombotic regimens.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet treatment is standard after coronary percutaneous interventions.
- This therapy reduces thrombotic events but increases bleeding risk.
- Advances in stenting aim to mitigate bleeding complications.
Purpose of the Study:
- To evaluate ticagrelor monotherapy versus dual antiplatelet therapy after coronary interventions.
- To assess the efficacy and safety of different antithrombotic strategies.
Main Methods:
- The GLOBAL LEADERS study compared ticagrelor monotherapy to standard dual antiplatelet therapy.
- Follow-up duration was 2 years.
- Outcomes included thrombotic and bleeding complications.
Main Results:
- Ticagrelor monotherapy did not demonstrate superiority over dual antiplatelet therapy in reducing thrombotic complications.
- The study did not show a significant advantage for monotherapy in the primary endpoints.
- However, the trial provides insights for future research.
Conclusions:
- Current clinical practice remains unchanged by the GLOBAL LEADERS trial findings.
- The study highlights the need for new trials exploring antithrombotic regimens.
- Future research should focus on regimens that are non-inferior in efficacy and superior in safety.
Abstract:
Dual antiplatelet treatment is currently the mainstay of pharmacologic treatment for patients after coronary percutaneous interventions for stable or acute coronary syndrome. The treatment decreases the incidence of thrombotic complications, but is responsible for an increased risk of bleeding. The advances in interventional cardiology and the development of new coronary stents, allow for a significant reduction of haemorrhagic complications secondary to antithrombotic treatment by either decreasing their dose or limiting their duration. The GLOBAL LEADERS study failed to demonstrate, after 2 years of follow-up, an advantage for the monotherapy with ticagrelor as compared to standard dual antiplatelet regimen. Nevertheless, focused appraisal of the study results, provide for some positive and promising new considerations. In fact, even though the results of the GLOBAL LEADER trial have not changed the current clinical practice, they provide the starting point for the design of new trials aiming at comparing new antithrombotic regimens which could be not inferior in terms of efficacy, but superior in terms of safety.
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