Continued Ticagrelor Use Linked with Reduced Major Bleeding After PCI in for Non-STEMI ACS Patients: Analysis

Continued use of ticagrelor was associated with lower major bleeding and a reduced risk for ischemic events at one year among patients with non-ST-elevation (non-STEMI) acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) on dual antiplatelet therapy (DAPT) with ticagrelor and aspirin, according to new findings presented at the American Heart Association 2019 Scientific Sessions in Philadelphia.

Study researchers assessed 7,119 patients from the randomized, placebo-controlled TWILIGHT trial between July 2015 and April 2018. High-risk patients underwent PCI and were treated with ticagrelor plus aspirin for three months. Event-free and adherent patients were randomized to aspirin versus placebo and continued ticagrelor for an additional year. Subsequent to completing three years of DAPT, all event-free patients were randomized to aspirin or placebo in double-blind fashion, followed by a continuation of ticagrelor for an additional 12 months.

Treatment with ticagrelor alone resulted in a significant 54% reduction in clinically relevant bleeding over the duration one year (3.6% vs. 7.6%; P<0.001), while also demonstrating a similar benefit for more severe BARC 3 or 5 bleeding (0.8% vs. 2.1%; P<0.001). The researchers observed that rates of all-cause mortality, myocardial infarction and stroke were similar between both groups (4.3% vs. 4.4%; P=0.84). The effect of ticagrelor monotherapy with respect to bleeding and ischemic events is uniform across different levels of risk. Results were unchanged for patients presenting with UA or non-STEMI.

“The effect of ticagrelor monotherapy with respect to bleeding and ischemic events is uniform across different levels of risk,” lead author Usman Baber, MD, MS, of the Icahn School of Medicine at Mount Sinai, noted in presentation slides. “Results are unchanged for patients presenting with UA or non-STEMI […] the results were concordant with the results of the TWILIGHT trial.”