Key result
Ticagrelor monotherapy after 3-month DAPT cuts bleeding ~80% in diabetic ACS without increasing ischemic risk.
Why the study?
The impact of ticagrelor monotherapy after 3 months of DAPT among patients with diabetes undergoing PCI remained unknown.
Does ticagrelor monotherapy after 3-months DAPT reduce bleeding events without increasing ischemic events in ACS patients with diabetes mellitus?
RCT (n=3,056)
Open-label
Computer generated and stratified according to diabetes status and ST-elevation MI
Yes
Does ticagrelor monotherapy after 3-months DAPT reduce bleeding events without increasing ischemic events in ACS patients with diabetes mellitus?
Hazard Ratio: 0.83 (95% CI 0.45–1.52)
Absolute Event Rate: 4.5% vs 5.5%
p-value: p=0.540
In ACS patients with diabetes, dropping aspirin after 3 months of DAPT and continuing ticagrelor monotherapy significantly reduces major bleeding without increasing ischemic risk compared to 12 months of DAPT.
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Ticagrelor monotherapy after 3-month DAPT may reduce late bleeding without raising ischemic risk in diabetic ACS patients post-PCI; leaves open dedicated confirmation before practice change.
Yun et al. (2021) conducted an RCT in Acute coronary syndrome (n=3,056). Ticagrelor monotherapy after 3-months DAPT vs. Ticagrelor-based 12-months DAPT was evaluated on Any ischemic events at 12 months in patients with diabetes (HR 0.83, 95% CI 0.45-1.52, p=0.540). In diabetic patients with acute coronary syndrome, ticagrelor monotherapy after 3 months of dual antiplatelet therapy significantly reduced bleeding events between 3 and 12 months (HR 0.20) without increasing ischemic complications compared to 12-month dual antiplatelet therapy.
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