Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients...

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is standard for acute coronary syndromes (ACS) post-drug-eluting stent (DES) placement.
• Discontinuing aspirin from DAPT is a bleeding reduction strategy, but ticagrelor monotherapy's role needs specific evaluation in ACS.

Purpose of the Study:

• To compare ticagrelor monotherapy after 3-month DAPT versus 12-month DAPT for net adverse clinical events in ACS patients with DES.
• To assess the safety and efficacy of abbreviated DAPT followed by ticagrelor monotherapy.

Main Methods:

• A randomized multicenter trial involving 3056 ACS patients treated with DES.
• Patients received either 3-month DAPT followed by ticagrelor monotherapy or 12-month ticagrelor-based DAPT.
• Primary outcome was a 1-year composite of major bleeding and major adverse cardiac and cerebrovascular events.

Main Results:

• Ticagrelor monotherapy after 3-month DAPT showed a statistically significant reduction in net adverse clinical events (3.9% vs 5.9%).
• Major bleeding was significantly lower in the ticagrelor monotherapy group (1.7% vs 3.0%).
• No significant difference was observed in major adverse cardiac and cerebrovascular events between groups.

Conclusions:

• Ticagrelor monotherapy after 3-month DAPT is a viable strategy for ACS patients with DES, offering a modest reduction in net adverse clinical events.
• This approach appears to reduce major bleeding without increasing major adverse cardiac and cerebrovascular events.
• Lower-than-expected event rates in the trial warrant consideration during interpretation.