RCT: Post-1 month ticagrelor monotherapy vs. dual antiplatelet therapy significantly reduces bleeding events in acute coronary syndromes

In this randomized, placebo-controlled, double-blind clinical trial, 3400 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) were assessed to compare the effects of ticagrelor alone versus ticagrelor plus aspirin from 1 to 12 months post-PCI. The study aimed to determine if ticagrelor alone could reduce bleeding without increasing major adverse cardiovascular or cerebrovascular events (MACCE). The primary findings indicated that ticagrelor alone resulted in significantly lower clinically relevant bleeding (2.1% vs. 4.6%, p<0.0001) and demonstrated non-inferiority in MACCE rates compared to the dual therapy group (3.6% vs. 3.7%, pnon-inferiority<0.0001). These outcomes suggest that ticagrelor monotherapy, starting one month post-PCI, may be an effective alternative to standard dual antiplatelet therapy in reducing bleeding risks without compromising safety.

Commentary on X:

Ticagrelor, in combination with #aspirin for 1 month, followed by ticagrelor alone,
after #PCI (GLOBAL LEADERS): a randomised superiority trial https://t.co/Bo8gfHIZLe

Register now to freely access #ESCCongress #LancetCardiology content up to Sept 10! https://t.co/6wOSrV9yXM pic.twitter.com/8EV5d8s1c8

— The Lancet (@TheLancet) August 27, 2018

Reference (link to abstract – $ for full-text):

Ge Z. et al. (2024). Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. The Lancet, 404(10102), 1173-1182. DOI: https://doi.org/10.1016/S0140-6736(24)00473-2.