Key result
Ticagrelor-monotherapy and ticagrelor-based DAPT comparably decreased hemostatic system activation, including MEA-ADP (Δmean -46.2 vs -51.4), at 2 hours and over 24 hours.
Why the study?
DAPT is standard in acute coronary heart disease but confers bleeding risk, prompting a comparison of ticagrelor monotherapy versus ticagrelor-based DAPT on hemostatic system activation.
Does ticagrelor monotherapy compared to ticagrelor-based DAPT comparably affect hemostatic system activation in healthy volunteers?
RCT (n=44)
randomized
Does ticagrelor monotherapy compared to ticagrelor-based DAPT comparably affect hemostatic system activation in healthy volunteers?
Absolute Event Rate: -46.2% vs -51.4%
Ticagrelor monotherapy provides comparable inhibition of hemostatic system activation to ticagrelor-based DAPT in healthy volunteers, supporting the physiological basis for dropping aspirin to reduce bleeding risk.
Supports dropping aspirin from ticagrelor regimens to lower bleeding; extends mechanistic rationale for de-escalation trials in patients.
Dual antiplatelet therapy (DAPT) is standard in acute coronary heart disease but confers a bleeding risk. To compare the effects of ticagrelor-monotherapy with ticagrelor-based DAPT on hemostatic system activation, we conducted a randomized controlled trial in 44 volunteers using a loading-dose regimen and measured platelet-aggregometry triggered by adenosine diphosphate (multiple electrode aggregometry (MEA)-ADP) and arachidonic acid (MEA-AA), the vasodilator-stimulated phosphoprotein (VASP), prothrombin fragment 1.2 (f1.2), and d-Dimer. Ticagrelor-based DAPT and ticagrelor-monotherapy significantly decreased MEA-ADP (Δmean: -51.4 (-56.9; -45.8) and -46.2 (-51.7; -40.7)) and VASP (Δmean: -70.3 (-76.2; -64.4) and -69.6 (-75.5; -63.7)) at 2 hours and over 24 hours. MEA-AA was reduced significantly by both treatments (Δmean: -72.9 (-80.6; -65.3) and -25.7 (-33.3; -18.0)) at 2 hours, and stronger by ticagrelor-based DAPT over 24 hours. Both treatments decreased f1.2 (geometric mean ratio (GMR): 0.92 (0.84; 1.01) and 0.88 (0.80; 0.96)) and d-Dimer (GMR: 0.89 (0.86; 0.92) and 0.91 (0.88; 0.94)) at 2 hours and d-Dimer over 24 hours. Ticagrelor-monotherapy and ticagrelor-based DAPT comparably affect hemostatic system activation.
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Traby et al. (2019) conducted an RCT in Healthy volunteers (n=44). Ticagrelor-monotherapy vs. Ticagrelor-based DAPT (ticagrelor with aspirin) was evaluated on Platelet-aggregometry triggered by adenosine diphosphate (MEA-ADP) at 2 hours. Ticagrelor-monotherapy and ticagrelor-based DAPT comparably decreased hemostatic system activation, including MEA-ADP (Δmean -46.2 vs -51.4), at 2 hours and over 24 hours.
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