Photo Credit: Christoph Burgstedt
The following is a summary of “Effectiveness and Safety of Ticagrelor Monotherapy After Short-Duration Dual Antiplatelet Therapy in PCI Patients: A Systematic Review and Meta-Analysis,” published in the January 2025 issue of Cardiology by Alagna et al.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor exists as the standard post-percutaneous coronary intervention (PCI) with drug-eluting stents (DES), but the optimal duration remains ambiguous due to the competing risks of ischemic events and bleeding.
Researchers conducted a retrospective study to evaluate the efficacy and safety of ticagrelor monotherapy after short-duration DAPT (1-3 months) compared to extended DAPT, focusing on major bleeding and cardiovascular outcomes.
They analyzed randomized controlled trials (RCTs) comparing ticagrelor monotherapy after short-duration DAPT with extended DAPT, sourced from PubMed, Embase, and the Cochrane Library and focused on major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, stroke, stent thrombosis, and mortality. Risk ratios (RR) with 95% CI were calculated using a random-effects model.
The results showed 5 RCTs with 32,393 patients demonstrated that ticagrelor monotherapy significantly reduced MACCE (RR: 0.88; 95% CI: 0.77-0.99; P =0.04) and major bleeding (RR: 0.53; 95% CI: 0.37-0.77; P =0.0008) compared to extended DAPT. Ticagrelor also reduced all-cause mortality (RR: 0.82; 95% CI: 0.67-0.99; P =0.04) and cardiovascular death (RR: 0.68; 95% CI: 0.49-0.94; P =0.02). The rates of myocardial infarction, stent thrombosis, and stroke were similar between the groups. Net adverse clinical events (NACE) were 27% lower with ticagrelor monotherapy (RR: 0.73; 95% CI: 0.63-0.85; P <0.0001).
Investigators concluded the ticagrelor monotherapy after short-duration DAPT reduced major bleeding complications while maintaining cardiovascular protection, offering a promising strategy for patients with PCI, especially those at high bleeding risk.
Source: ajconline.org/article/S0002-9149(25)00041-4/fulltext