Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial
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View abstract on PubMed
Summary
This summary is machine-generated.Stopping aspirin early after drug-eluting stent implantation for acute coronary syndrome with ticagrelor monotherapy is noninferior and superior to 12-month dual antiplatelet therapy (DAPT), significantly reducing major bleeding events.
Area Of Science
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background
- Dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) implantation for acute coronary syndrome (ACS) is debated.
- Shortening aspirin duration to <1 month with ticagrelor monotherapy has not been extensively studied in ACS patients.
Purpose Of The Study
- To evaluate if ticagrelor monotherapy after <1 month of DAPT is noninferior to 12 months of ticagrelor-based DAPT.
- To assess adverse cardiovascular and bleeding events in ACS patients undergoing DES implantation.
Main Methods
- A randomized, open-label, noninferiority trial involving 2850 ACS patients with DES implantation.
- Patients were assigned to ticagrelor monotherapy after <1 month DAPT or 12 months of ticagrelor-based DAPT.
- Primary endpoint: net clinical benefit (composite of death, MI, stent thrombosis, stroke, major bleeding) at 1 year.
Main Results
- Ticagrelor monotherapy after <1 month DAPT was noninferior and superior to 12-month DAPT (2.8% vs 5.2%, HR 0.54).
- Major bleeding events were significantly lower with early aspirin cessation (1.2% vs 3.4%, HR 0.35).
- The findings were consistent in the per-protocol analysis.
Conclusions
- Stopping aspirin within 1 month for ticagrelor monotherapy is a safe and effective strategy post-DES implantation in ACS.
- This approach significantly reduces major bleeding without compromising cardiovascular outcomes.
- Consider low event rates for patient risk stratification in future trial interpretations.
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