Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome
Why the study?
Discontinuing aspirin after short-term DAPT reduces bleeding, but ticagrelor monotherapy had not been exclusively evaluated in patients with acute coronary syndromes.
Does ticagrelor monotherapy after 3 months of DAPT reduce net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with acute coronary syndromes treated with drug-eluting stents?
Population
3056 patients with ACS treated with drug-eluting stents at 38 centers in South Korea
Comparison
Ticagrelor monotherapy after 3-month DAPT vs ticagrelor-based 12-month DAPT
Design
Randomized multicenter trial
Follow-up
1-year
Authors
Discussion
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Member takes
Overview
May support ticagrelor monotherapy after 3-month DAPT in ACS; extends de-escalation evidence from prior high-risk PCI trials.
Structured PICO
Does ticagrelor monotherapy after 3 months of DAPT reduce net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with acute coronary syndromes treated with drug-eluting stents?
P
Population
3,056 patients with acute coronary syndromes (ACS) treated with drug-eluting stents, mean age 61 years, 20% women, 36% ST-elevation myocardial infarction, based in South Korea.
I
Intervention
Ticagrelor monotherapy (90 mg twice daily) after 3 months of dual antiplatelet therapy (DAPT)
C
Comparator
Ticagrelor-based 12-month dual antiplatelet therapy (DAPT)
O
Outcome
1-year net adverse clinical event, defined as a composite of major bleeding and adverse cardiac and cerebrovascular events (death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization)composite
In patients with ACS treated with drug-eluting stents, dropping aspirin and continuing ticagrelor monotherapy after 3 months of DAPT significantly reduces net adverse clinical events at 1 year, driven primarily by a reduction in major bleeding without a significant increase in ischemic events.
Limitations
- Study population should be considered in interpreting the trial
- Lower than expected event rates
Cite This Study
Kim et al. (2020) studied this question.