23 May 2023 • New insights from the TWILIGHT trial, presented as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions showed that ticagrelor monotherapy after three months of ticagrelor plus aspirin was associated with similar rates of recurrent coronary revascularization, major adverse cardiac and cerebrovascular events (MACCE) and a lower risk of net adverse clinical events (NACE) compared with duel antiplatelet therapy (DAPT). The results were obtained from a randomized control trial of more than 7,000 patients.

• TWILIGHT is one of several recent studies that have focused on aspirin de-escalation after PCI.
• High-risk patients who were event-free and adherent to a ticagrelor-based DAPT for three months after PCI were randomized to ticagrelor plus aspirin or ticagrelor plus placebo for 12 additional months
• Among 7,039 patients, ticagrelor monotherapy and ticagrelor plus aspirin were associated with a similar risk of repeat revascularization (7.1% vs 6.6%)
• Among the main findings were lower rates of bleeding with monotherapy at 12 months and similar risk of death, MI, or stroke compared with DAPT.

“We found that ticagrelor monotherapy was as effective as ticagrelor plus aspirin in preventing clinically driven revascularization in the overall cohort and in select high-risk subgroups,” said Dr. Usman Baber, MD, who presented the findings.

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