Evaluating the risk of bleeding with ticagrelor alone or with aspirin after percutaneous coronary intervention

This study investigated the effect of ticagrelor (Brilique) with or without aspirin on bleeding risk after a percutaneous coronary intervention (PCI). 

They found that ticagrelor alone reduced bleeding risk compared to ticagrelor + aspirin in these patients.  

Coronary artery disease (CAD) is caused by reduced blood flow to the heart. This can lead to events such as heart attack and stroke. Percutaneous coronary intervention (PCI) is a surgical procedure to improve blood flow. During PCI the blockage in the artery is removed. In some cases, a stent may be inserted to keep a blood vessel open. 

Anti-platelet therapy (APT) is used before and after PCI. Platelets are cells in the blood that cause clotting. APT reduces the risk of clotting and further blockages after PCI. Aspirin is commonly used in APT. Ticagrelor is another APT drug. TCG targets P2Y12 receptors. This reduces platelet aggregation (clumping). One problem with APT is that it can increase the risk of bleeding. Major bleeding can be dangerous. Some studies suggest that ticagrelor alone may have a lower bleeding risk than combined with aspirin. 

This study included 7119 patients that underwent PCI. All patients were treated with ticagrelor + aspirin for the first 3 months. After this, patients were randomly assigned to ticagrelor alone or ticagrelor + aspirin. Bleeding events were recorded and categorized according to the severity. 

4% of ticagrelor alone and 7.1% of combination group patients had a bleeding event within 1 year. The risk of bleeding was 44% lower in the ticagrelor group compared to the combination group. The risk of grade severe to life-threatening bleeding events was 51% lower with ticagrelor only treatment. At 15 and 18 months, the risk of bleeding was similar in ticagrelor only and combination-treated patients. The risk of stroke, heart attack of death from any cause was 3.9% in both groups.

The authors concluded that ticagrelor alone reduced the bleeding risk after a PCI compared to ticagrelor and aspirin combined.

This trial was sponsored by Astra Zeneca, the manufacturer of ticagrelor. 

If you have any concerns regarding CAD please discuss it with your doctor.