Influence of early dose reduction of ticagrelor on clinical outcomes following percutaneous coronary intervention for complex lesions

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Ticagrelor-based dual antiplatelet therapy (DAPT) is effective but carries bleeding risks, especially in Asian populations.
• Percutaneous coronary intervention (PCI) for complex lesions requires potent antiplatelet therapy.
• Early dose reduction of ticagrelor may balance efficacy and safety.

Purpose of the Study:

• To evaluate the safety and clinical outcomes of early ticagrelor dose reduction in Korean patients post-PCI for complex lesions.
• To compare major adverse cardiovascular events (MACE), bleeding, and net adverse clinical events (NACE) between standard and reduced ticagrelor doses.

Main Methods:

• A multicenter prospective cohort study involving 772 patients on standard-dose ticagrelor-based DAPT post-PCI.
• 115 patients (14.8%) switched to a reduced ticagrelor dose (120 mg) within six months.
• Multivariable Cox proportional hazard models (CPH) and time-varying CPH models were used for analysis.

Main Results:

• No significant differences in MACE, bleeding, or NACE were observed between the low-dose (120 mg) and standard-dose (180 mg) ticagrelor groups.
• Results remained consistent across the entire follow-up and beyond six months post-PCI.
• Common reasons for dose reduction included planned switching, dyspnea, and bleeding.

Conclusions:

• Early ticagrelor dose reduction to 120 mg within six months after PCI is feasible and safe for Korean patients, including those with complex lesions.
• This strategy effectively manages the balance between ischemic risk and bleeding risk.
• The findings support individualized DAPT regimens based on patient response and tolerance.