ESC 2019 | THEMIS: Ticagrelor in Diabetics with Stable Coronary Artery Disease

The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable.

Primary end point rate (composite of cardiovascular death, infarction and stroke) occurred in 7.7% of patients receiving ticagrelor and aspirin vs. 8.5% receiving placebo and aspirin (p=0.04).

The cost of this benefit was to double the risk of major bleeding in patients receiving ticagrelor on top of significantly increasing the risk of intracranial bleeding.

Unless the risk of thrombotic events were high and at the same time the risk of bleeding were low, this study shows the net clinical benefit is not in favor of ticagrelor.


Read also: ESC 2019 | POPULAR AGE: Good Old Clopidogrel Still Valid.


The THEMIS included 19271 patients with stable CAD and diabetes randomized to aspirin plus 60 mg of ticagrelor every 12 hrs. (the dose was lowered from 90 mg to 60 mg after the PEGASUS-TIMI 54 outcomes) vs. aspirin plus placebo.

Patients with prior MI or stroke were excluded. It is worth mentioning that 58% of both arms had a history of PCI (which facilitated the THEMIS-PCI). More than half of patients presented angina and 62% had multivessel disease with a long history of diabetes (mean 10 years).

Primary end point reduction was driven by MI (16% less) and stroke (20% less) but cardiovascular death or all-cause death did not see any changes.

Bleeding cost was superior to the benefit above mentioned, which is why dual APT (ticagrelor and aspirin) in these patients seems not a good idea, which is similar to what we had observed years ago with clopidogrel in the CHARISMA study.

Original Title: Ticagrelor in patients with stable coronary disease and diabetes.

Reference: Steg PG et al. N Engl J Med. 2019; Epub ahead of print.

themis-articulo-original

Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Ultrathin vs Thin-Strut Stents in PCI Patients at High Bleeding Risk

Several in vivo studies have shown that ultrathin stents present lower thrombogenic risk vs. thin-strut stents, which reflects in lower rates of target lesion...

Should We Withdraw Anticoagulation Before TAVR?

Approximately one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have atrial fibrillation and are on oral anticoagulant (OAC) therapy. This creates a complex...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...