Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Limited data exists on antiplatelet therapy efficacy and safety across standardized body mass index (BMI) categories.
• Understanding these differences is crucial for optimizing treatment in diverse patient populations.

Purpose of the Study:

• To evaluate bleeding and ischemic outcomes associated with different antiplatelet regimens based on BMI.
• To analyze data from the TWILIGHT trial to stratify outcomes by BMI categories.

Main Methods:

• Secondary analysis of the TWILIGHT trial involving 7,038 high-risk patients post-percutaneous coronary intervention.
• Patients were stratified into normal weight (BMI 18.5-24.99 kg/m²), overweight (BMI 25-29.99 kg/m²), and obese (BMI ≥30 kg/m²) categories.
• Comparison of ticagrelor monotherapy versus ticagrelor plus aspirin regarding bleeding and ischemic events.

Main Results:

• Ticagrelor monotherapy significantly reduced Bleeding Academic Research Consortium (BARC) bleeding events (type 2, 3, or 5) across all BMI categories compared to ticagrelor plus aspirin.
• No significant increase in the composite ischemic endpoint (all-cause death, myocardial infarction, stroke) was observed with ticagrelor monotherapy across BMI strata.
• P-for-interaction values indicated consistent results across BMI categories for both bleeding and ischemic outcomes.

Conclusions:

• Ticagrelor monotherapy is a safe and effective antiplatelet strategy in high-risk patients undergoing PCI, irrespective of their BMI.
• This regimen reduces bleeding complications without compromising ischemic safety in normal weight, overweight, and obese individuals.
• Findings support individualized antiplatelet therapy selection based on patient characteristics, including BMI.