- Question
- To determine whether stopping aspirin within 1 month after drug-eluting stent implantation and continuing ticagrelor monotherapy is noninferior to 12 months of ticagrelor-based DAPT in patients with acute coronary syndrome.
- Design
- Randomized, open-label, noninferiority trial with 1:1 allocation, enrolling 2850 patients at 24 centers in South Korea. The primary analysis was by intention to treat with 1 year of follow-up.
- Population
- Patients with acute coronary syndrome undergoing drug-eluting stent implantation (mean age 61 years; 40% with ST-segment-elevation myocardial infarction).
- Intervention
- Ticagrelor monotherapy (90 mg twice daily) after less than 1 month of DAPT; aspirin was discontinued at a median of 16 days.
- Control
- 12 months of ticagrelor-based DAPT (ticagrelor 90 mg twice daily plus aspirin).
- Primary outcome
- Net clinical benefit at 1 year: composite of all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding.
- Results
- The primary endpoint occurred in 40 patients (2.8%) with monotherapy and 73 (5.2%) with 12-month DAPT (HR 0.54; 95% CI 0.37-0.80; P<0.001 for noninferiority; P=0.002 for superiority). Major bleeding was lower with monotherapy (1.2% vs 3.4%; HR 0.35; 95% CI 0.20-0.61).
- Safety
- The reduction in major bleeding was the main driver of the difference in the composite endpoint.
- Conclusion
- Stopping aspirin within the first month and continuing ticagrelor monotherapy was noninferior and superior to 12 months of DAPT for 1-year net clinical benefit, mainly through less major bleeding.
- Why it matters
- It supported very short DAPT followed by P2Y12 inhibitor monotherapy in acute coronary syndrome to reduce bleeding. The low event rates suggest relatively non-high-risk patients, which tempers interpretation.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026