Ticagrelor Post-DAPT Reduces Bleeding after PCI

Ticagrelor administered one month after dual antiplatelet (DAPT) therapy following multivessel percutaneous intervention (PCI) lowered bleeding, new study results indicate.

“Data on optimal antiplatelet treatment regimens in patients who undergo multivessel PCI are sparse,” the researchers for the GLOBAL LEADERS trial wrote in their abstract, published in the Journal of the American College of Cardiology. “This post hoc study investigated the impact of an experimental strategy (one-month DAPT followed by 23-month ticagrelor monotherapy) versus a reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) according to multivessel PCI.”

The study design was that of a prospective, multicenter, open-label, randomized, controlled trial in which all-comer patients were randomly assigned (1:1) to either the experimental regimen with ticagrelor or the reference regimen. The primary outcome of interest was a composite of all-cause death or new Q-wave myocardial infarction at two years, with a secondary safety endpoint of Bleeding Academic Research Consortium type 3 or 5 bleeding.

The study population consisted of more than 15,000 patients (n=15,845), of whom 3,576 (22.4%) who had multivessel PCI had higher risk for ischemic and bleeding events at two years than those with single-vessel PCI. For the primary study endpoint, there was a reported interaction between the experimental ticagrelor regimen and multivessel PCI (HR=0.62; 95% CI, 0.44 to 0.88; P for interaction=0.031). The researchers reported that the difference was driven primarily by lower risk of all-cause mortality. The risk for Bleeding Academic Research Consortium type 3 or 5 bleeding was similar between the ticagrelor group and the standard group (HR=0.92; 95% CI, 0.61 to 1.39; P for interaction=0.754).

“Long-term ticagrelor monotherapy following 1-month DAPT can favorably balance ischemic and bleeding risks in patients with multivessel PCI,” the researchers concluded. “These findings should be interpreted as hypothesis-generating and need to be replicated in future dedicated randomized trials.”