TCT 2019 | TWILIGHT: Minimal DAPT in High Bleeding Risk Patients

Courtesy of the SBHCI.

Monotherapy with a P2Y12 inhibitor after a minimum period (3 months) of dual antiplatelet antiaggregation (DAPT) is a valid treatment option to reduce bleeding in patients at high risk of bleeding complications. 

Highlights TCT 2019

The present double-blind study presented at TCT 2019 simultaneously published in NEJM analyzed ticagrelor monotherapy (prior 3 months DAPT) vs DAPT in patients undergoing PCI at high risk of bleeding. 

After 3 months of ticagrelor + aspirin, patients free from ischemic or bleeding events were randomized to ticagrelor + placebo (ticagrelor monotherapy) vs. ticagrelor + aspirin (DAPT) up to 12 months. 

Of 9006 included patients, 7119 were finally randomized (the rest were excluded for presenting bleeding or ischemic events).

Read also: TCT 2019 | Onyx ONE: Durable Polymer vs. Polymer-Free Stent with Only One Month of Dual Antiplatelet Therapy.

Primary end point was BARC bleeding 2, 3 or 5.

At one year, primary end point was seen in 4% of patients randomized to ticagrelor + placebo vs. 7.1% in patients with ticagrelor + aspirin (p<0.001).

The difference was driven mainly by BARC 2 bleeding, since major bleeding (BARC 3 or 5) resulted similar, as was all cause death, non-fatal stroke and non-fatal infarction. 


PCI Patients at high risk of bleeding after 3 months DAPT can continue with ticagrelor monotherapy up to 12 months, reducing bleeding events with no risk of increasing ischemic events, compared against ticagrelor + aspirin. 

Courtesy of the SBHCI.

Link to the SBHCI publication HERE

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Original Title: TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy vs. Ticagrelor-Plus-Aspirin Beginning at 3 Months in High-Risk Patients Undergoing PCI.

Author of the Original Article: Roxana Mehran.

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