Ticagrelor monotherapy in patients with diabetes mellitus undergoing percutaneous coronary interventions: insights from the TWILIGHT trial
Why the study?
It was unknown whether the TWILIGHT antiplatelet regimen of ticagrelor monotherapy after 3 months of DAPT provides consistent findings in patients with diabetes mellitus undergoing PCI.
Does ticagrelor monotherapy reduce bleeding compared to ticagrelor plus aspirin in patients with diabetes mellitus undergoing PCI?
Population
2620 high-risk PCI patients with diabetes mellitus event-free after 3 months of DAPT
Comparison
Ticagrelor plus placebo vs ticagrelor plus aspirin
Design
Prespecified analysis of a multicentre double-blind randomized placebo-controlled trial
Follow-up
12 months
Authors
Discussion
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Member takes
Implication
May support dropping aspirin post-PCI to cut bleeding; leaves open need for randomized confirmation of ischemic safety.
Structured PICO
Does ticagrelor monotherapy reduce bleeding compared to ticagrelor plus aspirin in patients with diabetes mellitus undergoing PCI?
P
Population
2,620 patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI) with at least one drug-eluting stent and high-risk clinical/angiographic features, who completed 3 months of dual antiplatelet therapy without major bleeding or ischemic events. Mean age 64.8 years, 23.6% female, multinational (11 countries).
I
Intervention
Ticagrelor (90 mg twice daily) plus matching placebo for 12 months (after an initial 3-month period of ticagrelor plus aspirin).
C
Comparator
Ticagrelor (90 mg twice daily) plus enteric-coated aspirin (81-100 mg daily) for 12 months.
O
Outcome
Composite of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding between randomization and 1 year.safety
In patients with diabetes mellitus undergoing PCI, ticagrelor monotherapy after 3 months of DAPT significantly reduces clinically relevant bleeding without increasing ischemic events compared to ticagrelor plus aspirin.
Cite This Study
Angiolillo et al. (2020) studied this question.