Ticagrelor monotherapy the way forward after Percutaneous Coronary Interventions: An updated meta-analysis

Ticagrelor monotherapy the way forward after Percutaneous Coronary Interventions: An updated meta-analysis https://doi.org/10.1161/circ.150.suppl_1.4124335  Abstract  Background: With the advent of newer generation drug eluting stents, the chorus for shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCI) is getting louder and louder. Ticagrelor monotherapy after a short course of dual antiplatelet therapy has been studied in a few randomized controlled trials with promising results. We conducted a systematic review and meta-analysis comparing the ticagrelor monotherapy with dual antiplatelet therapy after short duration dual antiplatelet therapy in patients undergoing percutaneous coronary interventions. Methods: PubMed, Embase and Cochrane databases were searched for Randomized Control Trials comparing ticagrelor monotherapy to dual antiplatelet therapy after percutaneous coronary interventions and reported the outcomes of Major Adverse Cardiac Events including death, myocardial infarction or stroke (MACE); Major Adverse Cardiac and Cerebrovascular Events including death, myocardial infarction, stroke, stent thrombosis or target vessel revascularization (MACCE); Major bleeding; Death from any cause; CV death; Stent thrombosis and Target vessel revascularization (TVR). Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Statistical analysis was performed using Review Manager Web (Cochrane Collaboration). Heterogeneity was examined with I2test.  Results: Out of 3208 database results, 5 Randomized Control Trials with 32,393 patients were included; 16,188 (50%) received Ticagrelor monotherapy. Studies had mean follow-up ranging from 12 months to 24 months. Baseline characteristics  are as per Table 1. Safety endpoints of major bleeding (HR 0.50; 95% CI 0.38-0.66; p < 0.0001; I2= 23 %; Figure 1A), was significantly less with ticagrelor monotherapy. Efficacy endpoints of MACE ,MACCE, Death from any cause, CV Death, target vessel revascularization (TVR) and stent thrombosis were not significantly different between ticagrelor and dual antiplatelet therapy (Figure 1 and 2).  Conclusion: Ticagrelor monotherapy reduces major bleeding as compared to continued dual antiplatelet therapy for 12 months after percutaneous coronary interventions. Major ischemic outcomes were similar in both groups. Ticagrelor monotherapy may be the way forward after short duration of dual antiplatelet therapy in patients undergoing percutaneous coronary interventions.  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.