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For those undergoing percutaneous coronary intervention (PCI) with drug-eluting stents, dual antiplatelet therapy (DAPT)—a combination of aspirin and a P2Y12 inhibitor—remains the standard of care.
For PCI patients, ticagrelor monotherapy after short-duration dual antiplatelet therapy markedly reduces MACCE, major bleeding, all-cause mortality, and cardiovascular death without increasing ischemic events.
For those undergoing percutaneous coronary intervention (PCI) with drug-eluting stents, dual antiplatelet therapy (DAPT)—a combination of aspirin and a P2Y12 inhibitor—remains the standard of care. However, the ideal duration of DAPT continues to be a subject of ongoing debate, as clinicians must weigh the benefits of reducing ischemic events against the risk of bleeding.
This study scrutinized the efficacy and safety of transitioning to ticagrelor monotherapy after a short course of DAPT (1 to 3 months) when compared with continued long-term DAPT, with a focus on major bleeding and cardiovascular outcomes.
Randomized controlled trials (RCTs) comparing short-duration DAPT followed by ticagrelor monotherapy versus prolonged DAPT were sourced from Cochrane Library, Embase, and PubMed. In this systematic review and meta-analysis, the outcomes assessed included mortality, stroke, major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), stent thrombosis, and myocardial infarction. Utilizing a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were checked.
A total of 5 RCTs comprising 32,393 patients were incorporated. Compared to extended DAPT, ticagrelor monotherapy markedly reduced the risk of MACCE (RR: 0.88) and major bleeding (RR: 0.53). It also led to a prominent reduction in all-cause mortality (RR: 0.82) and cardiovascular death (RR: 0.68). Between the two groups, the rates of stroke, stent thrombosis, and myocardial infarction were same. Notably, net adverse clinical events were 27% lower in the ticagrelor monotherapy group (RR: 0.73).
Ticagrelor monotherapy after a short course of DAPT successfully lowered major bleeding without compromising cardiovascular safety. This strategy may be especially beneficial for those at elevated bleeding risk, offering a balanced approach to antiplatelet therapy after PCI. Further research is warranted to explore the most appropriate DAPT duration across diverse patient populations, particularly those at high ischemic risk.
American Journal of Cardiology
Effectiveness and Safety of Ticagrelor Monotherapy After Short-Duration Dual Antiplatelet Therapy in PCI Patients: A Systematic Review and Meta-Analysis
Giulia Alagna et al.
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