After PCI and 1 mo of DAPT for ACS, ticagrelor alone vs. continued DAPT for 11 mo reduced bleeding without increasing...

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).
• Bleeding risk is a concern with DAPT, prompting research into de-escalation strategies.
• Ticagrelor is a P2Y12 inhibitor commonly used in ACS management.

Purpose of the Study:

• To compare the efficacy and safety of ticagrelor monotherapy versus ticagrelor plus aspirin (DAPT) in ACS patients post-PCI.
• To determine if ticagrelor alone is non-inferior to DAPT for preventing major adverse cardiovascular events (MACE).
• To evaluate the incidence of bleeding events in both treatment arms.

Main Methods:

• The ULTIMATE-DAPT trial was a randomized, placebo-controlled, double-blind clinical trial.
• 1507 patients with ACS undergoing PCI were randomized to receive ticagrelor alone or ticagrelor plus aspirin from 1 to 12 months post-PCI.
• The primary endpoint was the composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke.

Main Results:

• Ticagrelor monotherapy was non-inferior to DAPT in preventing MACE (3.0% vs 3.7%, P=0.44).
• Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred less frequently in the ticagrelor monotherapy group (4.0% vs 7.0%, P=0.02).
• No significant difference was observed in the rate of definite or probable stent thrombosis.

Conclusions:

• Ticagrelor monotherapy is a safe and effective alternative to DAPT for patients with ACS after PCI.
• Reducing dual antiplatelet therapy to monotherapy with ticagrelor decreases bleeding risk without compromising ischemic protection.
• These findings support the use of ticagrelor monotherapy as a de-escalation strategy in this patient population.