Ann Intern Med

De-escalating dual antiplatelet therapy reduces bleeding risk in ASC patients

February 19, 2025

Study details: This systematic review and individual patient data meta-analysis included data from three randomized trials and compared de-escalation from dual antiplatelet therapy (DAPT) to ticagrelor monotherapy vs. continuing DAPT for 12 months in acute coronary syndrome (ACS) patients undergoing drug-eluting stent implantation.

Results: Individual patient data included 9,130 randomized ACS patients. The incidence of the primary ischemic endpoint was similar between the ticagrelor monotherapy and standard DAPT groups (1.7% vs. 2.1%; hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.63 -1.16). However, the primary bleeding endpoint was significantly lower in the ticagrelor monotherapy group (0.8% vs. 2.5%; HR, 0.30; 95% CI, 0.21 - 0.45). These results were consistent across patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina.

Clinical impact: De-escalating from dual antiplatelet therapy to ticagrelor alone was associated with a lower risk for major bleeding compared with continuing both medicines, without an increase in ischemic events. This approach may also offer a mortality benefit, particularly among women, warranting further investigation.

Source:

Lee YJ, et al. (2025, February 18). Ann Intern Med. De-escalating Dual Antiplatelet Therapy to Ticagrelor Monotherapy in Acute Coronary Syndrome: A Systemic Review and Individual Patient Data Meta-Analysis of Randomized Clinical Trials. https://pubmed.ncbi.nlm.nih.gov/39961108/