Ticagrelor monotherapy as a strategy to reduce the bleeding risk in patients with acute coronary syndrome who underwent percutaneous coronary intervention

It is known that the risk of thrombotic events in patients with acute coronary syndrome (ACS) is highest in the first year after the event. Regardless of the treatment tactics, dual antiplatelet therapy (DAPT) is prescribed for a year after. DAPT significantly prevents thrombotic events, primarily recurrent myocardial infarction. At the same time, the bleeding risk naturally increases. In recent years, convincing data have been obtained that the transition from DAPT to ticagrelor monotherapy 1-3 months after the event leads to a significant reduction in the bleeding risk without increasing the rate of thrombotic events compared to 12-month DAPT. The review analyzes data from randomized clinical trials comparing DAPT and ticagrelor monotherapy in patients with ACS and presents the provisions of Russian and international clinical guidelines for the treatment of ACS regarding ticagrelor monotherapy. The review aim is to rationale the advantage of ticagrelor monotherapy compared to standard DAPT in patients with ACS and percutaneous coronary intervention using a detailed analysis of randomized controlled trials and meta-analyses. The practical part presents the relevant sections of the clinical guidelines.