Ticagrelor alone vs. ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS
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View abstract on PubMed
Summary
This summary is machine-generated.Ticagrelor monotherapy after percutaneous coronary intervention with drug-eluting stents significantly reduced bleeding events in patients with or without non-ST elevation acute coronary syndromes (NSTE-ACS). This approach lowered bleeding risk without increasing ischemic events, particularly benefiting NSTE-ACS patients.
Area Of Science
- Cardiology
- Interventional Cardiology
- Pharmacology
Background
- Dual antiplatelet therapy (DAPT) with ticagrelor and aspirin is standard after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
- High bleeding risk is a concern in patients undergoing PCI, necessitating strategies to mitigate bleeding complications.
- The optimal antiplatelet strategy post-DAPT, especially in relation to clinical presentation (e.g., non-ST elevation acute coronary syndromes - NSTE-ACS), requires further investigation.
Purpose Of The Study
- To evaluate the efficacy of ticagrelor monotherapy versus ticagrelor plus aspirin in reducing clinically relevant bleeding events.
- To assess the impact of ticagrelor monotherapy on major ischemic events in patients with and without NSTE-ACS after PCI with DES.
- To compare the safety and efficacy of ticagrelor monotherapy across different clinical presentations.
Main Methods
- A pre-specified subgroup analysis of the TWILIGHT trial involving 9006 high-risk patients undergoing PCI with DES.
- Randomization of 7119 adherent and event-free patients after 3 months of DAPT to either ticagrelor plus placebo or ticagrelor plus aspirin for 12 months.
- Primary outcome: Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding. Key secondary outcome: Composite of all-cause death, myocardial infarction (MI), or stroke.
Main Results
- Ticagrelor monotherapy significantly reduced BARC 2, 3, or 5 bleeding by 53% in patients with NSTE-ACS (3.6% vs. 7.6%) and by 24% in stable patients (4.8% vs. 6.2%).
- The reduction in bleeding events with ticagrelor monotherapy was more pronounced in the NSTE-ACS subgroup.
- Rates of composite ischemic events (all-cause death, MI, or stroke) were similar between ticagrelor monotherapy and DAPT arms, irrespective of clinical presentation.
Conclusions
- Ticagrelor monotherapy is effective in reducing clinically meaningful bleeding events in patients with or without NSTE-ACS after completing initial DAPT post-PCI with DES.
- This strategy does not increase the risk of major ischemic events compared to continued DAPT.
- The findings support ticagrelor monotherapy as a viable option for selected high-risk patients to balance bleeding and ischemic risk.
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