Key result
Ticagrelor-based DAT shows similar MACCE and bleeding to clopidogrel-based DAT at 1 year.
Why the study?
Clopidogrel is the preferred P2Y12 inhibitor in dual antithrombotic therapy for anticoagulated patients after PCI to reduce bleeding risk, but its pharmacodynamic limitations raise concerns about ischemic protection, motivating an exploration of intensifying platelet inhibition with ticagrelor.
Does ticagrelor-based dual antithrombotic therapy improve ischemic outcomes without increasing bleeding compared to clopidogrel-based dual or triple antithrombotic therapy in anticoagulated patients undergoing PCI?
Observational (n=1,713)
Yes
Does ticagrelor-based dual antithrombotic therapy improve ischemic outcomes without increasing bleeding compared to clopidogrel-based dual or triple antithrombotic therapy in anticoagulated patients undergoing PCI?
In anticoagulated patients undergoing PCI, intensifying dual antithrombotic therapy with ticagrelor instead of clopidogrel did not reduce overall ischemic events, had comparable bleeding to clopidogrel-based DAT, and was associated with a higher rate of definite stent thrombosis.
Answers are grounded in this paper and cite their sources.
Comparable MACCE rates with ticagrelor-based DAT do not support switching from clopidogrel; leaves open stent thrombosis risk in observational data.
Background Dual antithrombotic therapy (DAT) after short-term triple antithrombotic therapy (TAT) is recommended in patients requiring chronic oral anticoagulation after percutaneous coronary intervention (PCI). Clopidogrel is the preferred P2Y₁₂ inhibitor to reduce bleeding risk, but its pharmacodynamic limitations raise concerns about ischemic protection. Aims This analysis explored the clinical consequences of intensifying platelet inhibition with ticagrelor as part of DAT in anticoagulated patients undergoing PCI. Methods Data were pooled from two prospective multicenter registries including anticoagulated patients undergoing PCI. Patients were classified by discharge medication: ticagrelor-based DAT, clopidogrel-based DAT, or clopidogrel-based TAT. The co-primary endpoints were a composite of all-cause mortality, myocardial infarction, definite stent thrombosis (ST), ischemic stroke or transient ischemic attack (MACCE) and clinically relevant or major bleeding (BARC 2, 3 or 5) at one year. Propensity score matching was used to adjust for baseline differences. Results Among 1713 patients, 5.8% received ticagrelor-based DAT, 61.5% clopidogrel-based DAT, and 32.7% TAT. Ticagrelor-based DAT had similar MACCE rates (11% vs 12.5%), though higher observed rates of definite ST compared to clopidogrel-based DAT which remained significant after matching (4.6% vs 0.4%, p=0.028). MACCE rates were similar in ticagrelor-based DAT and TAT (11.0% vs 10.4%) which sustained after matching. Bleeding rates did not differ significantly between the two DAT strategies (15% vs 14.3%), but bleeding occurred less frequently with ticagrelor-based DAT than with clopidogrel-based TAT (15% vs 21.4%). Conclusions Intensification of platelet inhibition with ticagrelor was not associated with improved ischemic outcomes while bleeding rates were comparable to clopidogrel-based DAT and lower than with TAT.
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Pol et al. (2026) conducted an observational in Anticoagulated patients undergoing percutaneous coronary intervention (PCI) (n=1,713). Ticagrelor-based dual antithrombotic therapy (DAT) vs. Clopidogrel-based DAT or clopidogrel-based triple antithrombotic therapy (TAT) was evaluated on Co-primary endpoints at one year: MACCE (composite of all-cause mortality, myocardial infarction, definite stent thrombosis, ischemic stroke, or transient ischemic attack) and clinically relevant or major bleeding (BARC 2, 3, or 5). Ticagrelor-based DAT had similar 1-year MACCE and bleeding to clopidogrel-based DAT, with lower bleeding than TAT.
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