Key result
Ticagrelor monotherapy after short DAPT cuts bleeding ~38% compared to standard DAPT.
Why the study?
The safety and efficacy of shorter-duration ticagrelor-based DAPT followed by ticagrelor monotherapy in patients undergoing complex PCI remains uncertain.
Does ticagrelor monotherapy after a short course of ticagrelor-based DAPT reduce bleeding and ischemic events compared to standard DAPT in patients undergoing complex PCI?
Meta-Analysis (n=8,385)
Does ticagrelor monotherapy after a short course of ticagrelor-based DAPT reduce bleeding and ischemic events compared to standard DAPT in patients undergoing complex PCI?
Relative Risk: 0.62 (95% CI 0.47–0.81)
p-value: p=<0.001
In patients undergoing complex PCI, a short course of ticagrelor-based DAPT followed by ticagrelor monotherapy reduces bleeding and mortality without increasing ischemic risk compared to standard DAPT.
Supports ticagrelor monotherapy after short DAPT in complex PCI to cut bleeding and mortality; extends prior RCT evidence to this high-risk population.
(1) Shorter-duration dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy has been shown to significantly reduce bleeding events while preserving anti-ischemic effects in patients undergoing conventional percutaneous coronary interventions (PCI). Whether this strategy is also safe and effective in complex PCI remains elusive; (2) A systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT versus standard DAPT in patients undergoing complex PCI was performed; (3) Of 10,689 studies screened, 3 were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor-based DAPT, and 4209 on standard DAPT. The pooled analysis revealed no difference in the outcomes of major bleeding, myocardial infarction, definite or probable stent thrombosis and ischemic stroke. A significant reduction in the risk of cardiovascular death (incidence rate ratio (IRR) 0.52; 95% CI 0.28–0.96; p = 0.04), all-cause death (IRR 0.65; 95% CI 0.49–0.86; p = 0.003), and any bleeding events (IRR 0.62; 95% CI 0.47–0.81; p < 0.001) was seen in the shorter DAPT group; (4) Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.
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Condello et al. (2021) conducted a meta-analysis in Complex Percutaneous Coronary Intervention (n=8,385). Ticagrelor monotherapy after a short course of ticagrelor-based DAPT vs. Standard DAPT was evaluated on Any bleeding events (IRR 0.62, 95% CI 0.47-0.81, p=<0.001). Ticagrelor monotherapy after a short course of dual antiplatelet therapy significantly reduced any bleeding events (IRR 0.62) and cardiovascular death (IRR 0.52) compared to standard DAPT.