Post-PCI De-escalation of Ticagrelor to Clopidogrel Reduces Bleeding Risk Without Increasing Ischemic Events in CKD Patients: JAMA

A new study published in the Journal of American Medical Association showed that switching from ticagrelor to clopidogrel one month after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) significantly reduced bleeding risk without increasing ischemic events in patients with chronic kidney disease (CKD).

A major risk factor for ischemic and hemorrhagic sequelae after PCI for acute myocardial infarction is chronic kidney disease. Improving clinical results requires optimizing dual antiplatelet treatment (DAPT). Thus, to determine if an 11-month, unguided deescalation approach from ticagrelor to clopidogrel was linked to decreased bleeding without an increase in ischemic events in stable patients with CKD following AMI, Sang Hyun Kim and colleagues carried out this trial.

A total of 32 major cardiac hospitals in South Korea participated in this clinical study Ticagrelor vs. Clopidogrel in Stabilized Patients With Acute Myocardial Infarction (TALOS-AMI), which was the subject of this post hoc secondary analysis. The trial comprised patients with biomarker-positive AMI who were able to tolerate ticagrelor-based DAPT for one month following PCI.

The patients were enrolled between February 2014 and December 2018, and they were followed up with at 30, 3, 6, and 12 months following PCI. The subgroup of CKD patients was the focus of the current investigation. Analysis of the data took place between July 2023 and October 2024. The main outcome was a composite of bleeding (Bleeding Academic Research Consortium [BARC] categories 2, 3, or 5) and myocardial infarction, stroke, and cardiovascular disease mortality.