Highlights from

ACC 2020

Together with World Congress of Cardiology

Virtual 28 - 30 March 2020

Fewer adverse events with ticagrelor monotherapy after 3 months DAPT

Ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) has shown a significantly lower risk of ischaemia and bleeding events than the currently recommended 12-month DAPT with ticagrelor and aspirin, with the reduced risk mainly due to decreased major bleeding [1].

The objective of the TICO trial, presented by Prof. Yangsoo Jang (Yonsei University, South Korea), was to investigate ticagrelor monotherapy after 3 months of DAPT versus ticagrelor-based, 12-month DAPT for patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with new-generation, drug-eluting stents (DES). The study enrolled 3,065 ACS patients (mean age 61 years) undergoing PCI with the second-generation, ultrathin, biodegradable, polymer-coated, sirolimus-eluting stents. All patients received ticagrelor plus aspirin for 3 months after which they were randomised to continue treatment with ticagrelor alone (n=1,527) or ticagrelor and aspirin (n= 1,529). The primary study endpoint was a net clinical benefit composite of death, myocardial infarction, stroke, stent thrombosis, revascularisation, or Thrombolysis in Myocardial Infarction (TIMI) major bleeding at 12 months.

The results showed that 3.9% of patients on ticagrelor monotherapy reached the primary endpoint compared with 5.9% of patients continuing DAPT (HR 0.66; P=0.01). Interestingly, there was a clear difference in event rate at 3 months after randomisation with 1.4% of ticagrelor monotherapy patients achieving the composite endpoint versus 3.5% of those on DAPT (HR 0.41; P=0.001). TIMI major bleeding at 1 year was present in 1.7% of patients on ticagrelor monotherapy versus 3% of DAPT patients (HR 0.56; P=0.02). No difference was observed in ischaemic events between the 2 groups. Although the study had some limitations, such as the open-label design, no placebo group, and exclusion of patients with an elevated risk for bleeding, it was concluded that ticagrelor monotherapy could be an optimal strategy balancing both ischaemic and bleeding risks for patients with ACS.

  1. Kim B-K, et al. Ticagrelor With Or Without Aspirin In Acute Coronary Syndrome After Percutaneous Coronary Intervention: Randomized Evaluation Of Ticagrelor Monotherapy After 3-month Dual-antiplatelet Therapy In Acute Coronary Syndrome. Abstract 410-08. ACC/WCC 28-30 March 2020.

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