Objective: Short-term duration of dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy after percutaneous coronary intervention (PCI) among patients at high bleeding risk (HBR) was identified in numerous clinical trials, but the effect of ticagrelor monotherapy as an initial regimen was unknown. To explore the efficacy and safety of ticagrelor monotherapy after PCI in patient at HBR. Patients and methods: This were case series report at single center, unblinded without control group. A total of 12 acute coronary syndrome (ACS) patients at HBR between November 2020 and December 2021 were enrolled,17 newer generation drug-eluting stents (DES),2 drug-coated balloon (DCB) and 1 bioresorbable scaffolds (BRS) were implanted. Ticagrelor monotherapy was prescribed as an initial antiplatelet strategy after PCI. Study endpoints were major adverse cardiovascular events (MACEs) and major bleeding events at 1-month to 1-year follow-up. Results: During hospitalization and at the 1–3-month follow-up, there were no adverse clinical events, including ischemic or major bleeding events, in any of the patients. Six patients completed 1-year clinical event-free follow-up, 2 of them had well angiographic outcomes after PCI for one year. Conclusions: Ticagrelor monotherapy as an initial antiplatelet therapy was safety and efficacy in these patients at HBR undergoing PCI. Further prospective studies and randomized clinical trials are warranted.

Objective: Short-term duration of dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy after percutaneous coronary intervention (PCI) among patients at high bleeding risk (HBR) was identified in numerous clinical trials, but the effect of ticagrelor monotherapy as an initial regimen was unknown. To explore the efficacy and safety of ticagrelor monotherapy after PCI in patient at HBR. Patients and methods: This were case series report at single center, unblinded without control group. A total of 12 acute coronary syndrome (ACS) patients at HBR between November 2020 and December 2021 were enrolled,17 newer generation drug-eluting stents (DES),2 drug-coated balloon (DCB) and 1 bioresorbable scaffolds (BRS) were implanted. Ticagrelor monotherapy was prescribed as an initial antiplatelet strategy after PCI. Study endpoints were major adverse cardiovascular events (MACEs) and major bleeding events at 1-month to 1-year follow-up. Results: During hospitalization and at the 1–3-month follow-up, there were no adverse clinical events, including ischemic or major bleeding events, in any of the patients. Six patients completed 1-year clinical event-free follow-up, 2 of them had well angiographic outcomes after PCI for one year. Conclusions: Ticagrelor monotherapy as an initial antiplatelet therapy was safety and efficacy in these patients at HBR undergoing PCI. Further prospective studies and randomized clinical trials are warranted.