Optimal timing of aspirin discontinuation with ticagrelor monotherapy in acute coronary syndrome: a post hoc comparative analysis from the TICO and T-PASS trials
Primary result · Composite of all-cause death, myocardial infarction, stent thrombosis, ischaemia-driven target vessel revascularisation, stroke, and major bleedingResult — go to the resultHazard ratio 0.56 95% CI 0.37–0.84Authors' conclusion
Aspirin discontinuation within 1 month followed by ticagrelor monotherapy improved net clinical outcomes compared with 3-month discontinuation, primarily by reducing major bleeding without increasing ischaemic risk.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) who received ticagrelor monotherapy after abbreviated dual antiplatelet therapy (DAPT)patients who received ticagrelor monotherapy after abbreviated DAPT, after propensity score matching, 2,248 patients were included in the final analysis · discontinued aspirin within 1 month 1,426 · discontinued aspirin at 3 months 1,527
- Participants
- 2,953 patients
- Comparison
- <1-month group vs 3-month group
- <1-month groupn = 1,426
- 3-month groupn = 1,527reference
- Primary endpoint
- Composite of:
- All-cause death
- Myocardial infarction
- Stent thrombosis
- Ischaemia-driven target vessel revascularisation
- Stroke
- Major bleeding
- Follow-up
- 1 year
Methodological detailsindividual patient-level data from the TICO and T-PASS trials, propensity score matching
- Individual patient-level data from the TICO and T-PASS trials
- Propensity score matching
Primary result
As reported in the abstract
Composite of:
- All-cause death
- Myocardial infarction
- Stent thrombosis
- Ischaemia-driven target vessel revascularisation
- Stroke
- Major bleeding
Hazard ratio
0.56
95% CI 0.37–0.84
P = 0.005
By group
<1-month group vs 3-month group
HR 0.56 (95% CI 0.37–0.84); P = 0.005
Further findings
| Outcome | <1-month group | 3-month group | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Ischaemic events | 2.2% | 2.3% | 0.86 (0.55–1.65) | P = 0.863 | |
| 0.512Hazard ratio (log scale) |
Landmark analysis
- Event rates diverged primarily within the first 90 days, with no significant heterogeneity between the early and late periods
Safety
| Outcome | <1-month group | 3-month group | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Major bleeding · significantly lower in the <1-month group | 1.1% | 3.3% | 0.32 (0.17–0.61) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
Original publication
Optimal timing of aspirin discontinuation with ticagrelor monotherapy in acute coronary syndrome: a post hoc comparative analysis from the TICO and T-PASS trials. EuroIntervention. Published 16 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it