Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial

Lee, Yong-Joon; Suh, Yongsung; Kim, Jung Sun; Cho, Yun-Hyeong; Yun, Kyeong Ho; Kim, Yong Hoon; Cho, Jae Young; Her, Ae Young; Cho, Sungsoo; Jeon, Dong Woon; Yoo, Sang-Yong; Cho, Deok-Kyu; Hong, Bum–Kee; Kwon, Hyuck Moon; Hong, Sung Jin; Ahn, Chul‐Min; Shin, Dong Ho; Nam, Chung Mo; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Hong, Myeong Ki; Jang, Yangsoo

doi:10.4070/kcj.2021.0321

Cited by 19 publications

(12 citation statements)

References 23 publications

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“…The remaining 4 RCTs (TWILIGHT, 17 SMART-CHOICE, 18 REDUCE, 19 and TICO 20 trials) compared 3-month DAPT with standard DAPT. Furthermore, GLOBAL LEADERS, STOPDAPT-2, 21 TWILIGHT, 22 and TICO 23 analyzed the duration of DAPT in patients at HBR.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Shortened Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Hui

Bai

Liang

et al. 2022

Journal of Cardiovascular Pharmacology

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To update the efficacy and safety of short-term (#3 months) dual antiplatelet therapy (DAPT) and standard (6-12 months) DAPT in patients undergoing percutaneous coronary intervention. In addition, we also explored the duration of DAPT in patients at high bleeding risk (HBR). In PubMed, Embase, and Cochrane Library, we electronically searched among all the studies from the establishment of the database to December 8, 2021, for randomized controlled trials (RCTs). Nine randomized controlled trials (45,661 patients) ultimately met the inclusion criteria. The pooled analysis revealed that, compared with standard DAPT, #3month DAPT significantly reduced major adverse cardiovascular event {hazard ratio (HR) = 0.89, 95% confidence interval (CI) [0.82-0.97]}, all-cause mortality [HR = 0.88, 95% CI (0.78-0.99)], cardiovascular mortality [HR = 0.79, 95% CI (0.65-0.97)], major bleeding [HR = 0.72, 95% CI (0.56-0.93)], and any bleeding [HR = 0.57, 95% CI (0.50-0.66)], while no significant differences in the risk of myocardial infarction, stent thrombosis, and stroke. In patients with HBR, the results showed that #3-month DAPT significantly reduced major bleeding [HR = 0.35, 95% CI (0.14-0.88)] and any bleeding [HR = 0.53, 95% CI (0.41-0.67)] compared with standard DAPT, while the risk of other outcomes was not statistically different. In conclusion, this study showed that #3-month DAPT may be a valid option for most patients after percutaneous coronary intervention. Because reductions in major adverse cardiovascular event, all-cause mortality, and cardiovascular mortality were not seen in patients with HBR, this also highlights the need for specific studies in these patients about optimal duration of antiplatelet therapy.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Shortened Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Hui

Bai

Liang

et al. 2022

Journal of Cardiovascular Pharmacology

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“…[18] A study in Korea (TICO) revealed that the incidences of NACEs and major bleeding were lower in patients with ACS undergoing PCI that were treated with ticagrelor monotherapy after 3 months of DAPT compared with those in patients treated with ticagrelor-based 12-month DAPT, and the effects were more prominent in patients with a high risk of bleeding. [19] In addition, the HOPE-TAILOR trial provided valuable information on a de-escalation strategy using half-dose prasugrel and ticagrelor in East Asian patients with ACS. The patients were pragmatically randomized to either prasugrel, ticagrelor, or clopidogrel groups, followed by a half-dose reduction at 1 month, or a conventional dose of 75 mg clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention

Lei

Yang

et al. 2023

Medicine

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To investigate the effect of different DAPTs in patients with ACS undergoing PCI, and to identify the most efficient DAPT to reduce the risk of ischemia and bleeding after PCI. Between March 2017 and December 2021, 1598 patients with ACS who underwent PCI were included in the study. The DAPT protocol included the clopidogrel group (aspirin 100 mg + clopidogrel 75 mg), ticagrelor group (aspirin 100 mg + ticagrelor 90 mg), de-escalation Group 1 (reduced dose of ticagrelor [from 90 mg to 60 mg]) after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]), and de-escalation Group 2 (switched from ticagrelor to clopidogrel after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]). All patients received a 12-month follow-up. The primary endpoint was net adverse clinical events (NACEs) that included the composite endpoints of cardiac death, myocardial infarction, ischemia-driven revascularization, stroke, and bleeding events. There were 2 secondary endpoints, major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding. No statistically significant difference was found in the incidence of NACEs between the 4 groups at the average 12-month follow-up (15.7% vs 19.2% vs 16.7% vs 20.4%). Cox regression analysis revealed that DAPT ticagrelor group regimen (hazard ratio [HR] 0.547; 95% confidence interval [CI]: 0.334–0.896; P = .017) were associated with a lower risk of MACCEs. Age (HR 1.024; 95% CI: 1.003–1.046; P = .022). DAPT de-escalation Group 2 regimen (HR 1.665; 95% CI: 1.001–2.767; P = .049) were marginally associated with a higher risk of MACCEs. Ticagrelor group regimen (HR 1.856; 95% CI: 1.376–2.504; P < .001) was associated with higher risk of bleeding events. Ticagrelor group regimen (HR 1.606; 95% CI: 1.179–2.187; P = .003) were associated with a higher risk of minor bleeding events. For patients with ACS underwent PCI, there were no significant difference in the incidence of NACEs between 3 and 12 months after PCI between de-escalation and non-de-escalation therapies. Compared with ticagrelor-based 12-month DAPT, there was no significant difference in MACCEs and bleeding events in patients receiving de-escalation treatment (ticagrelor reduction from 90 to 60 mg, 3 months after PCI).

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“…The main results of the TICO trial have been shown to be consistent in several subgroup analyses such as DM status [ 73 ], high-ischemic risk [ 74 ], ST-segment elevation myocardial infarction (STEMI) [ 75 ], and HBR status [ 76 ]. A complete list of the prespecified and post-hoc analyses performed by the TICO investigators are shown in Table S3 .…”

Section: P2y 12 Monotherapy Versus Dapt After Pcimentioning

confidence: 99%

P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention

Zhou

Angiolillo

Ortega‐Paz

2022

JCDD

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In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk of bleeding, which is independently associated with poor prognosis. The improvement of the safety profiles of drug-eluting stents has been critical in investigating and implementing shorter DAPT regimens. The introduction into clinical practice of newer generation oral P2Y12 inhibitors such as prasugrel and ticagrelor, which provide more potent and predictable platelet inhibition, has questioned the paradigm of standard DAPT durations after coronary stenting. Over the last five years, several trials have assessed the safety and efficacy of P2Y12 inhibitor monotherapy after a short course of DAPT in patients treated with PCI. Moreover, ongoing studies are testing the role of P2Y12 inhibitor monotherapy immediately after PCI in selected patients. In this review, we provide up-to-date evidence on the efficacy and safety of P2Y12 inhibitor monotherapy after a short period of DAPT compared to DAPT in patients undergoing PCI as well as outcomes associated with P2Y12 inhibitor monotherapy compared to aspirin for long-term prevention.

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Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial

Cited by 19 publications

References 23 publications

Efficacy and Safety of Shortened Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of Shortened Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention

P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention

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