AHA 2019 | TWILIGHT: Discontinue Aspirin after Acute Coronary Syndrome

This study findings confirm less bleeding at no extra cost of thrombotic events when aspirin is discontinued after an acute coronary syndrome (ACS). 

AHA 2019 | TWILIGHT: discontinuar la aspirina luego de un síndrome coronario agudo

In the same line as the original TWILIGHT, this study focused on ACS patients alone (excluding STEMI) and confirmed that aspirin discontinuation after 3-month DAPT to continue with ticagrelor alone, reduced the risk of bleeding without increasing the risk of ischemic events. 

 

The benefits of ticagrelor monotherapy were the same across the whole spectrum of non-ST elevation ACS. 


Read also: AHA 2019 | RECOVERY: Early Surgery in Asymptomatic Severe Aortic Stenosis.


This sub-study included 4614 non-ST elevation ACS patients of the main study (2494 unstable angina patients and 2120 NSTEMI patients).

34.2% of patients presented 1 to 3 clinical or angiographical risk characteristics, 48.6% presented 4 to 5 and 17.3% presented 6 or more. One third of patients were diabetic and four were active smokers or had a history of MI. Mean stent length was 40 mm and treatment adherence was high.

Primary end point, BARC bleeding 2, 3 or 5, was significantly lower in the group that received ticagrelor monotherapy as of the third month vs those that continued with aspirin + ticagrelor (3.6% vs 7.6%; HR 0.47; CI 95% 0.36-0.61).

This advantage in bleeding did not bring along increased ischemic events, which resulted similar between the groups (4.3% vs 4.4%; HR 0.97; CI 95% 0.74-1.28).


Read also: AHA 2019 | GALILEO-4D: Rivaroxaban in the Prevention of Post TAVR Valve Thickening and Thrombosis.


Results were consistent regardless risk factors and clinical presentation. 

twilight-acs-presentacion-aha2019

Original Title: Ticagrelor with aspirin or alone in high-risk patients after coronary intervention for acute coronary syndrome.

Reference: Baber U. Presentado en el congreso AHA 2019. Noviembre 17, 2019. Philadelphia, PA.


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

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 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

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...