In ACS, Ticagrelor Monotherapy After <1 Month DAPT Outperforms Aspirin Continuation

30 Oct 2023 • Among patients with ACS who receive drug-eluting stents, dropping aspirin after less than 1 month of dual antiplatelet therapy (DAPT) with ticagrelor is superior to continuing with both drugs through 12 months, according to new data from the randomized T-PASS trial. These findings were presented at the 2023 TCT Conference last week.

T-PASS Findings

  • Among 2850 patients who were randomized (mean age, 61 years; 40% ST-elevation myocardial infarction), 2823 (99.0%) completed the trial.
  • Aspirin was discontinued at a median of 16 days in the group receiving ticagrelor monotherapy after <1 month of DAPT.
  • The primary endpoint was the net clinical benefit as a composite of all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding at 1 year
  • The primary endpoint occurred in 40 patients (2.8%) in the group receiving ticagrelor monotherapy after <1-month DAPT, and in 73 patients (5.2%) in the ticagrelor-based 12-month DAPT group.
  • The occurrence of major bleeding was significantly lower in the ticagrelor monotherapy after <1-month DAPT group compared with the 12-month DAPT group (1.2% versus 3.4%)

Stopping aspirin within 1 month after implantation of a drug-eluting stent (DES) for ticagrelor monotherapy has not been exclusively evaluated for patients with acute coronary syndrome (ACS). This study provides evidence that stopping aspirin within 1 month for ticagrelor monotherapy is both noninferior and superior to 12-month DAPT as for the 1-year composite outcome of death, myocardial infarction, stent thrombosis, stroke, and major bleeding, primarily due to a significant reduction in major bleeding, among ACS patients receiving DES implantation.

Source: Circulation | Read full story

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