# Ticagrelor monotherapie na ACS: IPD meta-analyse van vroege aspirinestop

*geplaatst 2024-02-20 · Algemeen · Circulation · doi 10.1161/CIRCULATIONAHA.123.067283 · https://hartvaat.nl/2024/02/20/ticagrelor-monotherapie-na-acs-ipd-meta-analyse-van-vroege-aspirinestop/*

IPD meta-analyse bevestigde dat vroege aspirinestop met ticagrelor monotherapie na ACS en PCI veilig is met minder bloedingen. Het ischemische risico nam niet toe, wat de-escalatie naar monotherapie na 1-3 maanden DAPT ondersteunt.

## English: Safety and Efficacy of Ticagrelor Monotherapy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An Individual Patient Data Meta-Analysis of TWILIGHT and TICO Randomized Trials.

This individual patient data meta-analysis confirmed that early aspirin cessation with ticagrelor monotherapy after ACS and PCI is safe with significantly less bleeding, without increasing the risk of ischemic events. The pooled patient-level evidence provides the strongest support for this de-escalation strategy.

## Abstract (original, from the publication)

BACKGROUND: Dual antiplatelet therapy with a potent P2Y12 inhibitor coupled with aspirin for 1 year is the recommended treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). As an alternative, monotherapy with a P2Y12 inhibitor after a short period of dual antiplatelet therapy has emerged as a bleeding reduction strategy. METHODS: We pooled individual patient data from randomized trials that included patients with ACS undergoing PCI treated with an initial 3-month course of dual antiplatelet therapy followed by ticagrelor monotherapy versus continued ticagrelor plus aspirin. Patients sustaining a major ischemic or bleeding event in the first 3 months after PCI were excluded from analysis. The primary outcome was Bleeding Academic Research Consortium type 3 or 5 bleeding occurring between 3 and 12 months after index PCI. The key secondary end point was the composite of death, myocardial infarction, or stroke. Hazard ratios and 95% CIs were generated using Cox regression with a one-stage approach in the intention-to-treat population. RESULTS: The pooled cohort (n=7529) had a mean age of 62.8 years, 23.2% were female, and 55% presented with biomarker-positive ACS. Between 3 and 12 months, ticagrelor monotherapy significantly reduced Bleeding Academic Research Consortium 3 or 5 bleeding compared with ticagrelor plus aspirin (0.8% versus 2.1%; hazard ratio, 0.37 [95% CI, 0.24-0.56]; P<0.001). Rates of all-cause death, myocardial infarction, or stroke were not significantly different between groups (2.4% versus 2.7%; hazard ratio, 0.91 [95% CI, 0.68-1.21]; P=0.515). Findings were unchanged among patients presenting with biomarker-positive ACS. CONCLUSIONS: Among patients with ACS undergoing PCI who have completed a 3-month course of dual antiplatelet therapy, discontinuation of aspirin followed by ticagrelor monotherapy significantly reduced major bleeding without incremental ischemic risk compared with ticagrelor plus aspirin. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42023449646.

Auteurs: Usman Baber, Yangsoo Jang, Angelo Oliva, Davide Cao, Birgit Vogel, George Dangas, Samantha Sartori, Alessandro Spirito, Kenneth F Smith, Mattia Branca, Timothy Collier, Stuart Pocock, Marco Valgimigli, Byeong-Keuk Kim, Myeong-Ki Hong, Roxana Mehran

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.123.067283. Bijgewerkt 2026-07-03T13:29:50Z. 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.