{"id":"273ba3e80042","type":"article","url":"https://hartvaat.nl/2020/06/16/ticagrelor-monotherapie-versus-dapt-op-bloedingen-en-cv-events-bij-acs-jama-tico/","title":"Ticagrelor monotherapie versus DAPT op bloedingen en CV-events bij ACS: JAMA TICO","title_en":"Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.7580","source_url":"https://doi.org/10.1001/jama.2020.7580","authors":["Byeong-Keuk Kim","Sung-Jin Hong","Yun-Hyeong Cho","Kyeong Ho Yun","Yong Hoon Kim","Yongsung Suh","Jae Young Cho","Ae-Young Her","Sungsoo Cho","Dong Woon Jeon","Sang-Yong Yoo","Deok-Kyu Cho","Bum-Kee Hong","Hyuckmoon Kwon","Chul-Min Ahn","Dong-Ho Shin","Chung-Mo Nam","Jung-Sun Kim","Young-Guk Ko","Donghoon Choi","Myeong-Ki Hong","Yangsoo Jang"],"significance":8,"published":"2020-06-16","source_date":"2020-06-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"The TICO results showed that ticagrelor monotherapy after 3 months of DAPT significantly reduced major bleeding compared with continued ticagrelor plus aspirin at 1 year after PCI for ACS, without increasing cardiovascular events. The study reinforced the safety of early aspirin discontinuation.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA TICO-resultaten: ticagrelor monotherapie versus ticagrelor plus aspirine op ernstige bloedingen en CV-events bij ACS.","abstract_original":"IMPORTANCE: Discontinuing aspirin after short-term dual antiplatelet therapy (DAPT) was evaluated as a bleeding reduction strategy. However, the strategy of ticagrelor monotherapy has not been exclusively evaluated in patients with acute coronary syndromes (ACS). OBJECTIVE: To determine whether switching to ticagrelor monotherapy after 3 months of DAPT reduces net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with ACS treated with drug-eluting stents. DESIGN, SETTING, AND PARTICIPANTS: A randomized multicenter trial was conducted in 3056 patients with ACS treated with drug-eluting stents between August 2015 and October 2018 at 38 centers in South Korea. Follow-up was completed in October 2019. INTERVENTIONS: Patients were randomized to receive ticagrelor monotherapy (90 mg twice daily) after 3-month DAPT (n = 1527) or ticagrelor-based 12-month DAPT (n = 1529). MAIN OUTCOMES AND MEASURES: The primary outcome was a 1-year net adverse clinical event, defined as a composite of major bleeding and adverse cardiac and cerebrovascular events (death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization). Prespecified secondary outcomes included major bleeding and major adverse cardiac and cerebrovascular events. RESULTS: Among 3056 patients who were randomized (mean age, 61 years; 628 women [20%]; 36% ST-elevation myocardial infarction), 2978 patients (97.4%) completed the trial. The primary outcome occurred in 59 patients (3.9%) receiving ticagrelor monotherapy after 3-month DAPT and in 89 patients (5.9%) receiving ticagrelor-based 12-month DAPT (absolute difference, -1.98% [95% CI, -3.50% to -0.45%]; hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.92]; P = .01). Of 10 prespecified secondary outcomes, 8 showed no significant difference. Major bleeding occurred in 1.7% of patients with ticagrelor monotherapy after 3-month DAPT and in 3.0% of patients with ticagrelor-based 12-month DAPT (HR, 0.56 [95% CI, 0.34 to 0.91]; P = .02). The incidence of major adverse cardiac and cerebrovascular events was not significantly different between the ticagrelor monotherapy after 3-month DAPT group (2.3%) vs the ticagrelor-based 12-month DAPT group (3.4%) (HR, 0.69 [95% CI, 0.45 to 1.06]; P = .09). CONCLUSIONS AND RELEVANCE: Among patients with acute coronary syndromes treated with drug-eluting stents, ticagrelor monotherapy after 3 months of dual antiplatelet therapy, compared with ticagrelor-based 12-month dual antiplatelet therapy, resulted in a modest but statistically significant reduction in a composite outcome of major bleeding and cardiovascular events at 1 year. The study population and lower than expected event rates should be considered in interpreting the trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02494895."}