- Question
- Is a uniform, unguided switch from ticagrelor to clopidogrel safe and effective in stabilised patients with acute myocardial infarction treated with PCI, without platelet function or genetic testing?
- Design
- Open-label, assessor-masked, multicentre, non-inferiority randomised trial conducted at 32 centres in South Korea. A total of 2697 patients were randomised 1:1.
- Population
- Patients with acute myocardial infarction receiving aspirin and ticagrelor who had no major ischaemic or bleeding events during the first month after the index PCI.
- Intervention
- De-escalation to clopidogrel plus aspirin, without a clopidogrel loading dose at the switch and without test guidance.
- Control
- Continued ticagrelor plus aspirin (active control group).
- Primary outcome
- Composite of cardiovascular death, myocardial infarction, stroke, or BARC type 2, 3 or 5 bleeding from month 1 to month 12.
- Results
- The primary endpoint occurred in 59 patients (4.6%) with de-escalation and 104 (8.2%) with active control (non-inferiority p<0.001; HR 0.55; 95% CI 0.40-0.76; superiority p=0.0001). The composite of cardiovascular death, myocardial infarction or stroke was 2.1% vs 3.1% (HR 0.69; 95% CI 0.42-1.14; p=0.15).
- Safety
- BARC 2, 3 or 5 bleeding was less frequent with de-escalation (3.0% vs 5.6%; HR 0.52; 95% CI 0.35-0.77; p=0.0012).
- Conclusion
- In stabilised patients after myocardial infarction, uniform unguided de-escalation from ticagrelor to clopidogrel reduced net clinical events at 12 months, mainly through fewer bleeding events.
- Why it matters
- It provided evidence supporting a simple de-escalation of potent antiplatelet therapy during the maintenance phase, without platelet function testing, to reduce bleeding without losing ischaemic protection.
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 14, 2026