Walking the Line with Ticagrelor: Meta-Analysis Comparing the Safety and Efficacy of Ticagrelor Monotherapy after a Short Course of Ticagrelor-Based Dual Antiplatelet Therapy versus Standard Therapy in Complex Percutaneous Coronary Intervention

Abstract

(1) Shorter-duration dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy has been shown to significantly reduce bleeding events while preserving anti-ischemic effects in patients undergoing conventional percutaneous coronary interventions (PCI). Whether this strategy is also safe and effective in complex PCI remains elusive; (2) A systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT versus standard DAPT in patients undergoing complex PCI was performed; (3) Of 10,689 studies screened, 3 were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor-based DAPT, and 4209 on standard DAPT. The pooled analysis revealed no difference in the outcomes of major bleeding, myocardial infarction, definite or probable stent thrombosis and ischemic stroke. A significant reduction in the risk of cardiovascular death (incidence rate ratio (IRR) 0.52; 95% CI 0.28–0.96; p = 0.04), all-cause death (IRR 0.65; 95% CI 0.49–0.86; p = 0.003), and any bleeding events (IRR 0.62; 95% CI 0.47–0.81; p < 0.001) was seen in the shorter DAPT group; (4) Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

“…ST is a rare but fearsome complication of PCI. The evolution of PCI techniques, innovations in stent technologies, and advancements in antithrombotic therapy has significantly reduced the incidence of this complication [28][29][30][31][32]. ST is usually classified as early (within 30 days after stent implantation, further differentiated into acute-within 24 h of PCI and subacute-from 24 h to 30 days), late (between 1 month and 1 year after implantation), or very late (>1 year after implantation).…”

Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations

“…The choice of appropriate antiplatelet regimen, combined or not with anticoagulation, after complex percutaneous coronary intervention (PCI) such as bifurcation PCI, is a particular challenge, with new evidence continuing to emerge. 58,59 Studies comparing different medical strategies after bifurcation PCI (single vs dual antiplatelet therapy [DAPT], short vs long DAPT, DAPT vs triple therapy, different targets of platelet inhibition, etc) will be included in this category.…”