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Lookup NU author(s): Professor Vijay KunadianORCiD
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.Aims In standard time-to-first event analysis, early aspirin discontinuation followed by ticagrelor monotherapy has been shown to reduce bleeding without increasing ischaemic complications compared with ticagrelor plus aspirin after percutaneous coronary intervention (PCI). We evaluated whether these treatment effects are preserved when recurrent events are considered. Methods and results In this TWILIGHT trial post-hoc analysis, we assessed the effects of ticagrelor monotherapy on the total number of events that occurred over the 12-month follow-up among 7119 high-risk patients randomized to aspirin or placebo in addition to ticagrelor at 3 months post-PCI if event-free and adherent to treatment. There were 391 patients with at least one Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding (primary endpoint). Of those, 28 (7.2%) had a recurrent event. The total number of BARC 2, 3, or 5 bleeding events was 148 in the ticagrelor monotherapy arm compared with 278 with ticagrelor plus aspirin arm (P < 0.001). Among 272 patients with at least one key secondary ischaemic endpoint (all-cause death, myocardial infarction, or stroke), 37 (13.6%) sustained a recurrent event. Total ischaemic events were similar (155 vs. 159) in the two groups. Conclusion Among selected high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy followed by ticagrelor with or without aspirin, recurrent bleeding was less common than recurrent ischaemic events over 12 months. Analysis of total events indicates that ticagrelor monotherapy continues to be more effective than ticagrelor plus aspirin in reducing bleeding without a signal of ischaemic harm.
Author(s): Baber U, Cao D, Collier T, Sartori S, Dangas G, Angiolillo DJ, Vogel B, Kunadian V, Briguori C, Cohen DJ, Dudek D, Gibson CM, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Steg PG, Pocock S, Mehran R
Publication type: Article
Publication status: Published
Journal: European Heart Journal - Cardiovascular Pharmacotherapy
Year: 2025
Volume: 11
Issue: 1
Pages: 66-74
Print publication date: 01/01/2025
Online publication date: 17/10/2024
Acceptance date: 16/10/2024
ISSN (print): 2055-6837
ISSN (electronic): 2055-6845
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ehjcvp/pvae080
DOI: 10.1093/ehjcvp/pvae080
PubMed id: 39419783
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