Ticagrelor monotherapy directly after primary PCI for STEMI resulted in major adverse cardiac and cerebral events in 3.1% of patients versus 2.0% with DAPT (HR 1.54; 95% CI 0.26-9.24).
RCT (n=200)
open-label
randomized
Yes
Does ticagrelor monotherapy directly after primary PCI improve safety and reduce bleeding compared to DAPT in STEMI patients?
In a pilot study of STEMI patients after primary PCI, ticagrelor monotherapy showed no significant difference in ischemic events compared to DAPT, with a tendency toward reduced bleeding, though the small sample size precludes definitive safety conclusions.
Effect estimate: HR 1.54 (95% CI 0.26-9.24)
Absolute Event Rate: 3.1% vs 2%
This randomized multicenter open-label pilot study assessed the safety of ticagrelor monotherapy directly after primary PCI versus dual antiplatelet therapy (DAPT) in 200 STEMI patients. At three months, major adverse cardiac and cerebral events occurred in 3.1% of the experimental group (n=99) versus 2.0% in the control group (n=101) (HR: 1.54; 95%CI: 0.26-9.24), clinically relevant bleeding was observed in 4.2% versus 8.9% (HR: 0.46, 95%CI: 0.14-1.48), and clinically relevant non-access site bleeding in 2.0% versus 7.9% (HR:0.25, 95%CI: 0.05-1.19). Although no significant difference in ischemic events was observed between the novel concept of ticagrelor monotherapy and DAPT, safety cannot be confirmed given the small number of events. Additionally, there was a tendency for a reduction in clinically relevant non-access site bleeding events. Clinical Trial Registration: ClinicalTrials.gov ID: NCT05986968 https://www.clinicaltrials.gov/study/NCT05986968.
Woelders et al. (2026) conducted an RCT in ST-elevation myocardial infarction (n=200). ticagrelor monotherapy vs. dual antiplatelet therapy (DAPT) was evaluated on major adverse cardiac and cerebral events (HR 1.54, 95% CI 0.26-9.24). Ticagrelor monotherapy directly after primary PCI for STEMI resulted in major adverse cardiac and cerebral events in 3.1% of patients versus 2.0% with DAPT (HR 1.54; 95% CI 0.26-9.24).