Three months of dual antiplatelet therapy (DAPT) may be sufficient in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), a pooled analysis of clinical studies shows. Compared with the currently recommended 1 year of a potent P2Y12 inhibitor plus aspirin, study participants had significantly reduced major bleeding without incremental ischemic risk when they received 3 months of DAPT followed by ticagrelor monotherapy.
Using pooled individual patient data from randomized trials of patients with ACS undergoing PCI, the investigators looked at findings with an initial 3-month course of DAPT followed by ticagrelor monotherapy versus continued ticagrelor plus aspirin. The analysis excluded patients with a major ischemic or bleeding event in the first 3 months after PCI. Based on a primary outcome of Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding between 3 and 12 months after the index PCI, the authors found: “The pooled cohort (N = 7,529) was characterized by a mean age of 62.8 years, 23.2% of patients were female and 55% presented with biomarker positive ACS. Between 3 and 12 months, ticagrelor monotherapy significantly reduced BARC 3 or 5 bleeding as compared with ticagrelor plus aspirin (0.8% vs. 2.1%; HR 0.37, 95% CI 0.24-0.56; P < 0.001). Rates of all-cause death, [myocardial infarction], or stroke were not significantly different between groups (2.4% vs. 2.7%; HR 0.91, 95% CI 0.68-1.21; P = 0.515). Findings were unchanged among patients presenting with biomarker positive ACS.”