Safety and Efficacy of 1-Month Dual Antiplatelet Therapy (Ticagrelor + Aspirin) Followed by 23-Month Ticagrelor Monotherapy in Patients Undergoing Staged Percutaneous Coronary Intervention (A Sub-Study from GLOBAL LEADERS).

Kawashima, Hideyuki; Tomaniak, Mariusz; Ono, Masafumi; Wang, Rutao; Hara, Hironori; Gao, Chao; Takahashi, Kuniaki; Sharif, Faisal; Thury, Attila; Suryapranata, Harry; Walsh, Simon; Cotton, James; Carrie, Didier; Sabate, Manel; Steinwender, Clemens; Leibundgut, Gregor; Wykrzykowska, Joanna; de Winter, Robbert J; Garg, Scot; Hamm, Christian; ... (2021). Safety and Efficacy of 1-Month Dual Antiplatelet Therapy (Ticagrelor + Aspirin) Followed by 23-Month Ticagrelor Monotherapy in Patients Undergoing Staged Percutaneous Coronary Intervention (A Sub-Study from GLOBAL LEADERS). The American journal of cardiology, 138, pp. 1-10. Elsevier 10.1016/j.amjcard.2020.09.057

[img] Text
Safety and efficacy of 1-month dual antiplatelet therapy.....pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

Patients undergoing staged percutaneous coronary intervention (SPCI) are exposed to extended duration of antiplatelet therapy, and a novel aspirin-free antiplatelet regimen after SPCI should be specifically evaluated among these patients. This is a prespecified substudy of the GLOBAL LEADERS which is a randomized, open-label trial, comparing an experimental regimen of 1-month dual antiplatelet therapy (DAPT; ticagrelor and aspirin) followed by 23-month ticagrelor monotherapy to a reference regimen of 12-month DAPT followed by 12-month aspirin monotherapy. Patients were stratified according to whether or not SPCI was performed. The impact of the timing of SPCI on clinical outcomes was also investigated. Of 15,968 randomized patients, 1,651 patients underwent SPCI within 3 months. These patients with SPCI had a significantly higher risk of bleeding and ischemic endpoints than those without SPCI. In patients undergoing SPCI, the primary endpoint (composite of all-cause death or new Q-wave myocardial infarction at 2 years) and secondary safety endpoint (Bleeding Academic Research Consortium [BARC]-defined bleeding 3 or 5) were similar in the 2 regimens. However, in patients presenting with acute coronary syndrome (ACS), the experimental regimen reduced a risk of BARC 3 or 5 bleeding (1.8% vs 4.5%; HR 0.387; 95% CI 0.179 to 0.836; p = 0.016). In patients undergoing SPCI later than 10 days after index procedure, this risk reduction was still prominent (0.8% vs 2.3%; HR 0.321; 95% CI 0.116 to 0.891; p = 0.029). In conclusion, patients undergoing SPCI are at high risk and may need special attention from clinicians. In ACS patients undergoing SPCI, a novel aspirin-free antiplatelet regimen appears to be associated with a lower bleeding risk than with standard DAPT.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-9149

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

04 Dec 2020 06:15

Last Modified:

16 Dec 2020 01:33

Publisher DOI:

10.1016/j.amjcard.2020.09.057

PubMed ID:

33065080

BORIS DOI:

10.7892/boris.147518

URI:

https://boris.unibe.ch/id/eprint/147518

Actions (login required)

Edit item Edit item
Provide Feedback