Ticagrelor with or without Aspirin in High-Risk Patients after PCI

After a minimum term of dual antiplatelet medication, monotherapy with a P2Y12 inhibitor is an emerging strategy for reducing the risk of bleeding after percutaneous coronary intervention (PCI). This Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention (TWILIGHT) trial was designed to test the hypothesis that a 3-month course of dual antiplatelet therapy with ticagrelor plus aspirin followed by ticagrelor monotherapy is superior to ticagrelor plus aspirin in patients undergoing PCI who are at risk of ischemic or hemorrhagic complications. In this double-blind trial, the effects of ticagrelor monotherapy vs. ticagrelor plus aspirin were examined with respect to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. A total of 7119 patients were randomized after 3 months. Between the time span of randomization and 1 year, the primary endpoint incidence was found to 4% in patients who received ticagrelor plus placebo and 7.1% in patients who received ticagrelor plus aspirin with the hazard ratio of 0.56. Between the two groups, the difference in risk was found to be similar for BARC type 3 or 5 bleeding with 1% incidence in patients receiving ticagrelor plus placebo and 2% among patients receiving ticagrelor plus aspirin with the hazard ratio of 0.49. The incidence of death from any cause nonfatal myocardial infarction, or nonfatal stroke was found to be 3.9% in both groups. In conclusion, this study demonstrates that ticagrelor monotherapy results in lower incidence of clinically relevant bleeding than ticagrelor plus aspirin with no evidence of death, myocardial infarction, or stroke among patients high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy. 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.