# Diabetes-factoren en ticagrelor plus aspirine: THEMIS en THEMIS-PCI

*geplaatst 2021-05-18 · Preventie · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2021.03.298 · https://hartvaat.nl/2021/05/18/diabetes-factoren-en-ticagrelor-plus-aspirine-themis-en-themis-pci/*

THEMIS subanalyse naar diabetes-gerelateerde factoren en het effect van ticagrelor plus aspirine.

## English: Diabetes-Related Factors and the Effects of Ticagrelor Plus Aspirin in the THEMIS and THEMIS-PCI Trials.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2021.03.298. Bijgewerkt 2026-07-03T13:28:19Z. 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.