Key result
Early de-escalation to low-dose ticagrelor-based dual antiplatelet therapy was not associated with a significant difference in the risk of major adverse cardiovascular events compared to standard-dose therapy (HR 0.81).
Why the study?
Ticagrelor-based DAPT provides potent antiplatelet inhibition but may increase bleeding risk in Asian populations, prompting investigation into early low-dose TDAPT after PCI.
Does early switching to low-dose ticagrelor-based dual antiplatelet therapy reduce bleeding without increasing ischemic events compared to standard-dose ticagrelor in patients undergoing PCI for complex lesions?
Cohort (n=772)
Yes
Does early switching to low-dose ticagrelor-based dual antiplatelet therapy reduce bleeding without increasing ischemic events compared to standard-dose ticagrelor in patients undergoing PCI for complex lesions?
Answers are grounded in this paper and cite their sources.
Ticagrelor-based dual antiplatelet therapy (TDAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the impact of the early use of low-dose TDAPT (l-TDAPT; 120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients on standard-dose TDAPT (s-TDAPT; 180 mg) after PCI for complex lesions. A major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization. A net clinical event (NCE) was defined as a composite of bleeding events and MACEs. Among the 772 patients on s-TDAPT, 115 (14.8%) switched to l-TDAPT within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariate Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding events, and NCE were not different between the l-TDAPT and s-TDAPT groups during the entire follow-up period and beyond 6 months after PCI. Multivariate time-varying CPH also showed similar results. De-escalation with low-dose ticagrelor within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.
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Lee et al. (2023) conducted a cohort in Acute coronary syndrome with complex coronary lesions (n=772). Low-dose ticagrelor-based dual antiplatelet therapy vs. Standard-dose ticagrelor-based dual antiplatelet therapy (180 mg daily) was evaluated on Major adverse cardiovascular event (MACE) (HR 0.81, 95% CI 0.29-2.30, p=0.695). Early de-escalation to low-dose ticagrelor-based dual antiplatelet therapy was not associated with a significant difference in the risk of major adverse cardiovascular events compared to standard-dose therapy (HR 0.81).
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