De-escalating Dual Antiplatelet Therapy to Ticagrelor Monotherapy in Acute Coronary Syndrome : A Systematic Review and Individual Patient Data Meta-analysis of Randomized Clinical Trials
Authors' conclusion
In patients with ACS undergoing DES implantation, de-escalating DAPT to ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without an increase in ischemic events, regardless of the type of ACS.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing drug-eluting stent (DES) implantationrandomized patients with ACS from 3 trials (TICO, T-PASS, ULTIMATE-DAPT) · STEMI 3,132 · non-STEMI (NSTEMI) 3,023 · unstable angina 2,975
- Participants
- 9,130 patients
- Comparison
- De-escalating dual antiplatelet therapy (DAPT) to ticagrelor monotherapy versus ticagrelor-based standard DAPT for 12 months
- Outcome
- Coprimary end points: ischemic end point (composite of death, nonprocedural [spontaneous] myocardial infarction, or stroke) and bleeding end point (Bleeding Academic Research Consortium types 3 or 5 bleeding)
Pooled result
As reported in the abstract
Ticagrelor monotherapy
- Primary ischemic end point
- 1.7%
- Primary bleeding end point
- 0.8%
Standard DAPT
- Primary ischemic end point
- 2.1%
- Primary bleeding end point
- 2.5%
Primary ischemic end point
Ticagrelor monotherapy1.7%
Standard DAPT2.1%
Primary bleeding end point
Ticagrelor monotherapy0.8%
Standard DAPT2.5%
ticagrelor monotherapy vs standard DAPTHazard ratio (95% CI)
Primary ischemic end point; not different
0.85(0.63–1.16)
Primary bleeding end point; lower in the ticagrelor monotherapy group
0.30(0.21–0.45)
Further pooled results
Primary end points by ACS type (STEMI, NSTEMI, unstable angina)
- These findings were consistent in patients with STEMI, NSTEMI, and unstable angina.
Original publication
De-escalating Dual Antiplatelet Therapy to Ticagrelor Monotherapy in Acute Coronary Syndrome : A Systematic Review and Individual Patient Data Meta-analysis of Randomized Clinical Trials. Ann Intern Med. Published 18 February 2025. doi:10.
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