Ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) is associated with lower incidences of major bleeding without an increase in ischemic events compared with ticagrelor-based 12-month DAPT, a new study shows. In meta-analysis findings presented Saturday at Cardiovascular Research Technologies (CRT) 2024 in Washington, D.C., the results were observed in patients with acute coronary syndrome (ACS) undergoing drug-eluting stent (DES) implantation. Discussing their methodology, the Korean-based research team revealed that they had performed the individual patient data meta-analysis from the TICO and T-PASS randomized controlled trials (RCTs). “[We] aimed to perform a systematic review and individual patient data meta-analysis from RCTs evaluating the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS undergoing DES implantation,” said Myeong-Ki Hong, MD, PhD, from Severance Hospital, Yonsei University College of Medicine in Seoul, South Korea. “Several meta-analyses based on previous RCTs have demonstrated the benefit of P2Y12 inhibitor monotherapy after short-term DAPT,” he added. “However, these meta-analyses included RCTs characterized by heterogeneity regarding clinical presentation, type of P2Y12 inhibitor, timing of randomization, and clinical endpoints of interest.” Results of meta-analysis Data from 5,906 ACS patients revealed that the rate of primary efficacy endpoint did not differ between the ticagrelor monotherapy group (n=2953) and the ticagrelor-based DAPT group (n=2953). Findings revealed the rates between the two groups were 1.9% versus 2.5%; (hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.55-1.10; P=0.159). In addition, the rate of primary safety endpoint was significantly lower in the ticagrelor monotherapy group (2.4% versus 4.5%; hazard ratio [HR]=0.53; 95% confidence interval [CI]=0.40-0.71; P<0.001). “The results were consistent in aggregate data meta-analysis including ACS subgroup of additional randomized clinical trials,” the meta-analysis concluded. Use of potent P2Y12 inhibitors has been preferentially recommended over clopidogrel in ACS, with several experimental antiplatelet therapy strategies proposed to improve clinical outcomes by achieving a better balance of the risk of ischemic events and of bleeding These include the 2023 European Society of Cardiology guidelines for ACS management, the Academic Research Consortium’s consensus document discussing modulation of antiplatelet therapy in patients with coronary artery disease, and the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines for coronary artery revascularization. Methodology Electronic databases were searched, and individual patient data were pooled from the relevant RCTs that compared ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT in ACS patients undergoing DES implantation. After applying the pre-specified eligibility criteria, two RCTs (the TICO and T-PASS) were deemed eligible after full text review. An individual patient-level data meta-analysis was performed using an intention-to-treat population, and the primary analysis was based on a one-stage approach. The co-primary endpoints were efficacy endpoint (composite of all-cause death, myocardial infarction, or stroke) and safety endpoint (Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) at one year. Pre-specified sensitivity analyses for the primary endpoints were performed based on a two-stage approach. Photo Credit: Bailey Salimes/CRTonline.org Photo Caption: Myeong-Ki Hong, MD, PhD, shares findings from a meta-analysis of the TICO and T-PASS trials Saturday at CRT 2024 in Washington, D.C.