Ticagrelor monotherapy good enough after one month of DAPT among patients after PCI: Lancet

A recent trial found that patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) with stent placement may benefit more from a single antiplatelet therapy regimen after the first month by challenging the conventional 12-month dual therapy guideline. The findings were published in the recent edition of The Lancet journal.

Traditionally, the international clinical guidelines have recommended a 12-month course of dual antiplatelet therapy that comprised aspirin and a P2Y12 receptor inhibitor to reduce the risks of myocardial infarction and stent thrombosis. This study was conducted across a total of 58 centers in China, Italy, Pakistan and the United Kingdom with its findings suggesting a potential trend shift in the post-PCI care. This research included a total of 3,400 participants from the IVUS-ACS study and assessed the efficacy and safety of transitioning to ticagrelor monotherapy after just one month of dual therapy.

The research was conducted from September 2019 to October 2022 and randomized the patients who remained event-free for a month following their PCI to either continue with the standard dual therapy of ticagrelor plus aspirin or switch to ticagrelor plus a placebo, effectively testing the waters for ticagrelor monotherapy.

The findings indicated a significant reduction in clinically relevant bleeding events among the patients on ticagrelor monotherapy without an increase in the major adverse cardiovascular or cerebrovascular events (MACCE), which include cardiac death, myocardial infarction, ischemic stroke, definite stent thrombosis or clinically driven target vessel revascularization. Also, the clinically relevant bleeding occurred in only 2.1% of the ticagrelor-monotherapy group when compared to 4.6% in the dual-therapy group by marking a significant improvement in the patient safety.

Also, the occurrence of MACCE was nearly identical between the two groups, which demonstrates the non-inferiority of ticagrelor monotherapy to the dual-therapy regimen in preventing serious cardiac events. Overall, the findings of this research highlight the potential of ticagrelor monotherapy in reducing the bleeding risks and improve the protective role against the cardiac events.

Reference:

Ge, Z., Kan, J., Gao, X., Raza, A., Zhang, J.-J., Mohydin, B. S., Gao, F., Shao, Y., Wang, Y., Zeng, H., Li, F., Khan, H. S., Mengal, N., Cong, H., Wang, M., Chen, L., Wei, Y., Chen, F., Stone, G. W., … Chen, S.-L. (2024). Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. In The Lancet. Elsevier BV. https://doi.org/10.1016/s0140-6736(24)00473-2