{"id":"4fa963e39710","type":"article","url":"https://hartvaat.nl/2021/05/18/diabetes-factoren-en-ticagrelor-plus-aspirine-themis-en-themis-pci/","title":"Diabetes-factoren en ticagrelor plus aspirine: THEMIS en THEMIS-PCI","title_en":"Diabetes-Related Factors and the Effects of Ticagrelor Plus Aspirin in the THEMIS and THEMIS-PCI Trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.298","source_url":"https://doi.org/10.1016/j.jacc.2021.03.298","authors":["Lawrence A Leiter","Deepak L Bhatt","Darren K McGuire","Hwee Teoh","Kim Fox","Tabassome Simon","Shamir R Mehta","Eli I Lev","Róbert G Kiss","Anthony J Dalby","Héctor Bueno","Wilhelm Ridderstråle","Anders Himmelmann","Jayne Prats","Yuyin Liu","Jane J Lee","John Amerena","Mikhail N Kosiborod","Philippe Gabriel Steg"],"significance":6,"published":"2021-05-18","source_date":"2021-05-18","image":"","kennis":[],"congress":"","summary_en":"This THEMIS subanalysis examined diabetes-specific factors that modify the benefit of adding ticagrelor to aspirin, identifying which diabetic patients derive the greatest net clinical advantage from intensified antiplatelet therapy.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","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":"THEMIS subanalyse naar diabetes-gerelateerde factoren en het effect van ticagrelor plus aspirine.","abstract_original":"BACKGROUND: THEMIS (The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study) (n = 19,220) and its pre-specified THEMIS-PCI (The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study-Percutaneous Coronary Intervention) (n = 11,154) subanalysis showed, in individuals with type 2 diabetes mellitus (median duration 10.0 years; HbA1c 7.1%) and stable coronary artery disease without prior myocardial infarction (MI) or stroke, that ticagrelor plus aspirin (compared with placebo plus aspirin) produced a favorable net clinical benefit (composite of all-cause mortality, MI, stroke, fatal bleeding, and intracranial bleeding) if the patients had a previous percutaneous coronary intervention. OBJECTIVES: In these post hoc analyses, the authors examined whether the primary efficacy outcome (cardiovascular death, MI, stroke: 3-point major adverse cardiovascular events [MACE]), primary safety outcome (Thrombolysis In Myocardial Infarction-defined major bleeding) and net clinical benefit varied with diabetes-related factors. METHODS: Outcomes were analyzed across baseline diabetes duration, HbA1c, and antihyperglycemic medications. RESULTS: In THEMIS, the incidence of 3-point MACE increased with diabetes duration (6.7% for ≤5 years, 11.1% for >20 years) and HbA1c (6.4% for ≤6.0%, 11.8% for >10.0%). The relative benefits of ticagrelor plus aspirin on 3-point MACE reduction (hazard ratio [HR]: 0.90; p = 0.04) were generally consistent across subgroups. Major bleeding event rate (overall: 1.6%) did not vary by diabetes duration or HbA1c and was increased similarly by ticagrelor across all subgroups (HR: 2.32; p < 0.001). These findings were mirrored in THEMIS-PCI. The efficacy and safety of ticagrelor plus aspirin did not differ by baseline antihyperglycemic therapy. In THEMIS-PCI, but not THEMIS, ticagrelor generally produced favorable net clinical benefit across diabetes duration, HbA1c, and antihyperglycemic medications. CONCLUSION: Ticagrelor plus aspirin yielded generally consistent and favorable net clinical benefit across the diabetes-related factors in THEMIS-PCI but not in the overall THEMIS population."}