De-Escalating DAPT to Ticagrelor Monotherapy Cuts Bleeding Risk in Acute Coronary Syndrome

WEDNESDAY, Feb. 19, 2025 (HealthDay News) — For patients with acute coronary syndrome (ACS) undergoing drug-eluting stent (DES) implantation, de-escalating dual antiplatelet therapy (DAPT) to P2Y12 inhibitor monotherapy is associated with lower bleeding risk, without an increase in ischemic events, according to a review published online Feb. 18 in the Annals of Internal Medicine.

Yong-Joon Lee, M.D., from Severance Hospital at the Yonsei University College of Medicine in Seoul, South Korea, and colleagues compared the effects of de-escalating DAPT to ticagrelor monotherapy versus standard DAPT using data from randomized clinical trials involving patients with ACS. Individual patient data were obtained from three trials, including 9,130 randomized patients with ACS: 3,132 with ST-segment elevation myocardial infarction (STEMI); 3,023 with non-STEMI (NSTEMI); and 2,975 with unstable angina.

The researchers found no difference in the rate of the primary ischemic end point (composite of death, nonprocedural [spontaneous] myocardial infarction, or stroke) between the ticagrelor monotherapy and standard DAPT groups (1.7 versus 2.1 percent; hazard ratio, 0.85; 95 percent confidence interval, 0.63 to 1.16). The ticagrelor monotherapy group had a lower rate of the primary bleeding end point (0.8 versus 2.5 percent; hazard ratio, 0.30; 95 percent confidence interval, 0.21 to 0.45). The findings were consistent across STEMI, NSTEMI, and unstable angina.

“Our findings suggest that de-escalating DAPT to ticagrelor monotherapy will reduce aspirin-associated major bleeding while preserving the anti-ischemic benefits of antiplatelet therapy for patients with ACS of all types undergoing DES implantation,” the authors write.

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