Does ticagrelor alone reduce bleeding risk after percutaneous coronary intervention?

This study investigated the effect of ticagrelor (Brilique) with or without aspirin after a percutaneous coronary intervention (PCI). They found that ticagrelor alone reduced bleeding risk after PCI.

Coronary artery disease (CAD) is caused by blockages in the coronary arteries. This reduces blood flow to the heart. This starves the heart of oxygen and can lead to a heart attack or stroke. These are called major adverse cardiac events (MACE). Percutaneous coronary intervention (PCI) is used to remove a blockage. It is a surgical procedure that involves using a stent. The stent keeps the blood vessel open. A balloon is attached to the stent. This is used to remove the blockage. 

The risk of blockages after PCI is high. This is because blood cells called platelets may clump together and form another blockage. Dual antiplatelet therapy (DAPT) is used to reduce this risk. Aspirin is one drug used in DAPT. Another commonly used drug is ticagrelor. There are some risks with DAPT. Aspirin increases the risk of bleeding. This can be fatal. Some studies suggest treatment with ticagrelor only (monotherapy, MT) could reduce this risk. However, it is unclear if ticagrelor MT is effective after PCI. 

This study included 7019 patients undergoing PCI. All patients were treated with ticagrelor and aspirin for 3 months after PCI. Participants were then randomly assigned to ticagrelor and aspirin or ticagrelor and placebo (MT). The main outcomes were bleeding risk and MACE. 

Bleeding risk was 46% lower in the ticagrelor MT group after 1 year. The rates of MACE were similar in both groups. There was no difference in death rates between groups. 

The authors concluded that ticagrelor MT reduced bleeding risk after PCI.

Patients in this study underwent complex or non-complex PCI. This was not taken into account when assigning patients to treatment. There could be different effects in each group. More controlled studies are needed. 

If you have any concerns regarding CAD management, please discuss this with your physician.