Dropping aspirin after the first month and continuing with ticagrelor monotherapy was not better than standard dual antiplatelet therapy (aspirin plus ticagrelor or clopidogrel) in patients who underwent coronary angioplasty.
Patrick Serruys presented this work (which was simultaneously published in The Lancet) at the European Society of Cardiology (ESC) Congress 2018 and explained that, given the potent and consistent antiplatelet effect of ticagrelor, researchers came up with the hypothesis that ticagrelor monotherapy might be superior to aspirin.
Dual antiplatelet therapy for a few months after a scheduled angioplasty and for at least a year after suffering from acute coronary syndrome is still the standard of care.
This study included 15,968 participants who were randomized to 1-month dual antiplatelet therapy and then ticagrelor alone (no aspirin) vs. 12 months of dual antiplatelet therapy with aspirin plus ticagrelor or clopidogrel followed by 12 more months of aspirin monotherapy.
The primary endpoint (a composite of all-cause mortality or non-fatal infarction) occurred in 3.81% of participants treated with dual antiplatelet therapy followed by ticagrelor for 23 months and 4.37% of patients who received to standard therapy (p = 0.073).
As regards an expanded endpoint (all-cause mortality, non-fatal infarction, definite stent thrombosis, or Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding), there were no differences between both strategies. In pre-specified sub-groups, such as patients with acute coronary syndrome, there were no differences either.
In terms of safety, BARC 3 or 5 bleeding occurred in 2.04% of patients with dual antiplatelet therapy for 1 month followed by ticagrelor monotherapy vs. 2.12% of patients who received standard dual antiplatelet therapy.
Original title: Ticagrelor plus Aspirin for 1 Month, Followed by Ticagrelor Monotherapy for 23 Months Versus Aspirin plus Clopidogrel or Ticagrelor for 12 Months, Followed by Aspirin Monotherapy for 12 Months After Implantation of a Drug-Eluting Stent: A Multicenter, Open-Label, Randomized Superiority Trial.
Reference: Presented by Patrick Serruys at the European Society of Cardiology 2018 Congress in Munich and simultaneously published in The Lancet. 2018;Epub ahead of print.
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