Key result
Low-dose ticagrelor (60 mg twice daily) will be compared to standard-dose ticagrelor (90 mg twice daily) for non-inferiority regarding ischemic and bleeding events in a planned trial of 2,120 patients with acute coronary syndrome after percutaneous coronary intervention.
Why the study?
Standard-dose DAPT for 12 months after PCI in ACS increases bleeding risk, and whether low-dose ticagrelor with aspirin reduces bleeding while preserving anti-ischemic efficacy remains unclear.
Does low-dose ticagrelor combined with aspirin improve net clinical outcomes compared to standard-dose ticagrelor in ACS patients after successful PCI?
RCT (n=2,120)
Open-label
1:1 ratio via Interactive Web Response System (IWRS), stratified by ACS type, age, sex, and diabetes
Yes
Does low-dose ticagrelor combined with aspirin improve net clinical outcomes compared to standard-dose ticagrelor in ACS patients after successful PCI?
This study protocol outlines a trial to determine if low-dose ticagrelor with aspirin is non-inferior to standard-dose ticagrelor for ischemic events while reducing bleeding in Chinese ACS patients post-PCI.
If noninferior, low-dose ticagrelor may reduce bleeding without excess ischemia in ACS post-PCI; extends randomized dosing comparisons.
BackgroundCurrent guidelines recommend that patients with acute coronary syndrome (ACS) who have successfully undergone percutaneous coronary intervention (PCI) should continue to use dual antiplatelet therapy (DAPT) for 12 months. The long-term use of standard-dose dual antiplatelet therapy will increase the risk of bleeding. An optimized antiplatelet strategy that can prevent ischemic events and reduce the risk of bleeding remains to be explored.MethodsThe study is a prospective, multicenter, randomized, open-label, controlled study involving 2120 patients from six clinical centers in China. Through the Interactive Web Response System (IWRS), ACS patients undergoing successful PCI will be randomly divided into the low-dose ticagrelor group or the normal-dose ticagrelor group, after taking 100 mg aspirin and 90 mg ticagrelor bid for 1 week. The primary endpoint is a composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, repeat revascularization, stroke, and bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria at one year. The secondary endpoints are bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria at one year.DiscussionRecent studies have confirmed that 90 mg ticagrelor alone can safely and effectively reduce bleeding without increasing ischemic events of patients with ACS after PCI. Compared with standard-dose DAPT, whether low-dose ticagrelor combined with aspirin can ensure the anti-ischemic effect while reducing the bleeding risk remains unclear in Chinese patients.The Tiger study will be the first large-scale, multicenter study to compare the efficacy and safety of low-dose and standard-dose ticagrelor combined with aspirin in ACS patients one week after successful PCI.Trial registrationClinicaltrials.gov, NCT04255602. Registered on 5 February 2020.
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Pang et al. (2021) conducted an RCT in Acute coronary syndrome (ACS) after successful percutaneous coronary intervention (PCI) (n=2,120). Low-dose ticagrelor plus aspirin vs. Standard-dose ticagrelor (90 mg twice daily) plus aspirin 100 mg once daily was evaluated on Composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, repeat revascularization, stroke, and bleeding events of grade 2 or higher according to BARC criteria at one year. Low-dose ticagrelor (60 mg twice daily) will be compared to standard-dose ticagrelor (90 mg twice daily) for non-inferiority regarding ischemic and bleeding events in a planned trial of 2,120 patients with acute coronary syndrome after percutaneous coronary intervention.
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