TICO: Age Impacts the Effect of Antiplatelet Monotherapy

The higher the age, the greater the benefit of ticagrelor monotherapy vs. dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome.

This post hoc sub-analysis of the TICO study goes along the same lines as the TWILIGHT study (which we recently discussed), given that age is the most common reason for considering that a patient is at high risk of bleeding. 

The analysis sought to find an age-dependent effect in patients who received 3 months of DAPT and then were randomized to ticagrelor monotherapy vs. completing 12 months of DAPT.

To answer this question, TICO included 3056 patients (mean age 61 years) and defined as primary endpoint a composite of major bleeding, death, infarction, stent thrombosis, stroke, or target-vessel revascularization.

The effect on bleeding reduction increased gradually with age, peaking at 64 years.

Read also: Post-PCI Ticagrelor Monotherapy in High-Risk Bleeding.

Considering 64 years as the cutoff point, the occurrence of the primary endpoint was significantly lower with ticagrelor monotherapy compared with patients who completed one year of DAPT (4.4% vs 9.0%; p = 0.002). In younger patients (n=1778), the difference between the two strategies was not significant.

Conclusion

There is an age-dependent effect that increases the benefit of ticagrelor monotherapy (after 3 months of DAPT) vs. completing a year of DAPT in patients admitted with acute coronary syndrome. Discontinuing aspirin at 3 months is superior in the elderly compared with younger patients, for whom the difference between strategies is not significant.

Original Title: Age-Dependent Effect of Ticagrelor Monotherapy Versus Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events: A Post Hoc Analysis of the TICO Randomized Trial. 

Reference: Byung Gyu Kim et al. J Am Heart Assoc. 2021 Dec 21;10(24):e022700. doi: 10.1161/JAHA.121.022700.

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