Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR

Patients at a high risk of bleeding (HBR) are a common subgroup of those receiving percutaneous coronary intervention (PCI). After a short period of dual antiplatelet treatment (DAPT), early aspirin discontinuation has emerged as a bleeding prevention technique. It has been demonstrated by TWILIGHT trial that ticagrelor monotherapy is an effective and safe bleeding prevention approach for high-risk PCI patients, following a short course of DAPT. TWILIGHT-HBR was conducted with the pre-specified analysis of TWILIGHT trial to determine the treatment effects of ticagrelor monotherapy compared with ticagrelor plus aspirin in a contemporary high-bleeding risk group. In this trial, after 3 months of ticagrelor plus aspirin, event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor. The primary end point assessed was BARC type 2, 3, or 5 bleeding up to 1 year after randomization and the key secondary endpoint was the composite of all-cause death, MI, or stroke. A total of 1064 (17.2%) patients were HBR. HBR patients were older, more frequently female and of non-white race compared with non-HBR patients. They had more cardiovascular risk factors such as hypertension, diabetes, and peripheral artery disease, and were less frequently active smokers. The results of the TWILIGHT-HBR group demonstrated that ticagrelor monotherapy reduced the incidence of the primary endpoint of BARC 2, 3 or 5 bleeding in comparison to ticagrelor plus aspirin in HBR. The results demonstrated that ticagrelor monotherapy did not increase ischaemic events, including death, MI or stroke, irrespective of HBR status. In conclusion, aspirin discontinuation followed by aspirin monotherapy significantly reduced bleeding without increasing ischaemic events as compared to ticagrelor plus aspirin among HBR patients and absolute risk reduction in major bleeding was larger in HBR than non-HBR patients. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.