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

Patients at high bleeding risk represent a prevalent subgroup among those undergoing percutaneous coronary intervention. Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy. The aim of this study was to assess the effects of ticagrelor monotherapy in reducing the incidence of primary endpoint of 2, 3, or 5 BARC bleeding after 3-month dual antiplatelet therapy in a contemporary high bleeding risk population. Event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor, after 3 months of ticagrelor plus aspirin. At the end of the study, it was observed that Ticagrelor monotherapy had reduced incidence of the primary endpoint compared with ticagrelor plus aspirin i.e. (6.3% vs. 11.4% with hazard ratio (HR) 0.53, with absolute risk differences of−2.8%. A similar pattern was observed for more severe BARC 3 or 5 bleeding with a larger absolute risk reduction in high bleeding risk patients i. e−3.5% vs. −0.5% with significance of 0.008. There was no significant difference in the key secondary endpoint of death, myocardial infarction, or stroke between treatment arms, irrespective of HBR status. Thus, the study concluded that among high bleeding risk patients undergoing Percutaneous Coronary Intervention who completed 3-month DAPT without experiencing major adverse events, aspirin discontinuation followed by ticagrelor monotherapy significantly reduced bleeding without increasing ischaemic events, compared with ticagrelor plus aspirin. The absolute risk reduction in major bleeding was larger in high bleeding risk patients than non-high bleeding risk 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.