Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis.

Abstract

Dual antiplatelet therapy (DAPT) and subsequent P2Y12 inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared with standard DAPT (1-3 months of DAPT was termed "short-term" DAPT, 6-12 months DAPT was termed "standard" DAPT). The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke, and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE; myocardial infarction, stroke, all-cause death, stent thrombosis, and major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26,143 patients were included. The risk of MACE was similar between the two treatment groups (risk ratio (RR) 0.86, 95% confidence interval (CI), 0.72-1.02, P = 0.08, I2  = 22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65-0.98, P = 0.03, I2  = 0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71-0.94, P = 0.005, I2  = 33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49-0.92, P = 0.01, I2  = 65%). In patients with acute coronary syndrome, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin vs. ticagrelor monotherapy following PCI are needed.

• Authors: Georg Gelbenegger, Christian Schoergenhofer, Bernd Jilma, Gloria M Gager, Al Medina Dizdarevic, Mamas A Mamas, Biljana Parapid, Poonam Velagapudi, Jolanta M Siller-Matula
• Journal: Clinical pharmacology and therapeutics (Clin Pharmacol Ther) Vol. 110 Issue 2 Pg. 424-431 (08 2021) ISSN: 1532-6535 [Electronic] United States
• PMID: 33668076 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

Chemical References

• Platelet Aggregation Inhibitors
• Ticagrelor

Topics

• Acute Coronary Syndrome (complications, surgery)
• Cardiovascular Diseases (epidemiology, mortality)
• Drug Therapy, Combination
• Dual Anti-Platelet Therapy
• Hemorrhage (chemically induced, epidemiology)
• Humans
• Percutaneous Coronary Intervention (methods, mortality)
• Platelet Aggregation Inhibitors (therapeutic use)
• Stroke (epidemiology, mortality)
• Ticagrelor (therapeutic use)
• Treatment Outcome