In the TWILIGHT trial, switching from dual antiplatelet therapy (DAPT) with ticagrelor and aspirin to ticagrelor monotherapy at 3 months after percutaneous coronary intervention (PCI) was found to reduce the risk of bleeding without increasing the risk of ischaemic events. In two new analyses, similar benefits have been found in the subgroups of patients who underwent complex PCI or who had diabetes mellitus. In 2,342 patients who underwent complex PCI, the rate of BARC type 2, 3 or 5 bleeding was lower with ticagrelor monotherapy than with DAPT (4.2% versus 7.7%; HR 0.54, 95% CI 0.38–0.76), whereas the rate of ischaemic events (myocardial infarction, stroke or death) was not significantly different between the two groups (3.8% versus 4.9%). Similarly, in 2,620 patients with diabetes, the incidence of BARC type 2, 3 or 5 bleeding was lower with ticagrelor monotherapy than with DAPT (4.5% versus 6.7%; HR 0.65, 95% CI 0.47–0.91), but the rate of ischaemic events was not significantly different (4.6% versus 5.9%).
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Dangas, G. et al. Ticagrelor with aspirin or alone after complex PCI: the TWILIGHT-COMPLEX analysis. J. Am. Coll. Cardiol. https://doi.org/10.1016/j.jacc.2020.03.011 (2020)
Angiolillo, D. J. et al. Ticagrelor with or without aspirin in high-risk patients with diabetes mellitus undergoing percutaneous coronary intervention. J. Am. Coll. Cardiol. https://doi.org/10.1016/j.jacc.2020.03.008 (2020)
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Lim, G.B. Aspirin withdrawal in complex PCI and diabetes. Nat Rev Cardiol 17, 320 (2020). https://doi.org/10.1038/s41569-020-0376-x
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DOI: https://doi.org/10.1038/s41569-020-0376-x
