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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
'Aspirin versus ticagrelor for the management after coronary revascularization - a systematic review and
Dhiraj Raj Regmi1, Sabita Regmi2, Sachin Upreti3
1Nepalese Army Institute of Health Sciences (NAIHS), Bhandarkhal, Syanobharyang, Kathmandu, Nepal.
Insights
Ticagrelor monotherapy may reduce major adverse cardiovascular events and all-cause mortality in coronary artery disease patients post-revascularization compared to aspirin monotherapy, without increasing bleeding risk.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Coronary artery disease (CAD) management often involves antiplatelet therapy post-revascularization.
- Ticagrelor and aspirin are key antiplatelet agents, but their monotherapy efficacy and safety profiles require comparison.
Purpose of the Study:
- To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with CAD undergoing coronary revascularization.
- To evaluate the impact on major adverse cardiovascular events (MACE) and bleeding complications.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Included studies compared ticagrelor monotherapy with aspirin monotherapy after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- Primary outcome was MACE (all-cause mortality, myocardial infarction, stroke); secondary outcomes included bleeding and stent thrombosis.
Main Results:
- Five RCTs with 25,994 participants were analyzed.
- Ticagrelor monotherapy showed a significantly lower risk of MACE (RR 0.86) and all-cause mortality (RR 0.86) compared to aspirin.
- No significant differences were found in myocardial infarction, stroke, major bleeding, repeat revascularization, or stent thrombosis.
Conclusions:
- Ticagrelor monotherapy appears to reduce MACE and all-cause mortality post-coronary revascularization without increasing major bleeding.
- Findings were primarily driven by PCI trials and should be interpreted cautiously due to combined PCI and CABG populations.
Objective:
To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization.
Methods:
We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment.
Results:
Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; p = 0.012; I² = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; p = 0.023; I² = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; p = 0.138; I² = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; p = 0.913; I²=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; p = 0.976; I² = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; p = 0.452; I² = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; p = 0.481; I² = 0%).
Conclusion:
Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together.
Trial Registratrion:
CRD420261286239.
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