Ticagrelor with or without aspirin following percutaneous coronary intervention in high-risk patients with concomitant peripheral artery disease: A analysis of TWILIGHT randomized clinical trial

Ticagrelor with or without aspirin following percutaneous coronary intervention in high-risk patients with concomitant peripheral artery disease: A subgroup analysis of the TWILIGHT randomized clinical trial Am Heart J. 2024 Jun:272:11-22. doi: 10.1016/j.ahj.2024.03.002  Abstract Background: The optimal antiplatelet regimen after percutaneous coronary intervention (PCI) in patients with peripheral artery disease (PAD) is still debated. This analysis aimed to compare the effect of ticagrelor monotherapy versus ticagrelor plus aspirin in patients with peripheral artery disease undergoing percutaneous coronary intervention.  Methods: In the TWILIGHT trial, patients at high ischemic or bleeding risk that underwent percutaneous coronary intervention were randomized after 3 months of dual antiplatelet therapy (DAPT) to aspirin or matching placebo in addition to open-label ticagrelor for 12 additional months. In this post-hoc analysis, patient cohorts were examined according to the presence or absence of peripheral artery disease. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. The key secondary endpoint was a composite of all-cause death, myocardial infarction (MI), or stroke. Endpoints were assessed at 12 months after randomization.  Results: Among 7,119 patients, 489 (7%) had peripheral artery disease and were older, more likely to have comorbidities, and multivessel disease. Peripheral artery disease patients had more bleeding or ischemic complications than no- peripheral artery disease patients. Ticagrelor monotherapy compared to ticagrelor plus aspirin was associated with less BARC 2, 3, or 5 bleeding in peripheral artery disease (4.6% vs 8.7%; HR 0.52; 95%Cl  0.25-1.07) and no- peripheral artery disease patients (4.0% vs 7.0%; HR 0.56; 95%CI 0.45-0.69; interaction P-value .830) and a similar risk of death, myocardial infarction, or stroke in these 2 groups (interaction P-value .446).  Conclusions: Despite their higher ischemic and bleeding risk, patients with Peripheral artery disease undergoing percutaneous coronary intervention derived a consistent benefit from ticagrelor monotherapy after 3 months of dual antiplatelet therapy in terms of bleeding reduction without any relevant increase in ischemic events.   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.