- Question
- In patients at high bleeding or ischemic risk who underwent percutaneous coronary intervention (PCI), does stopping aspirin after 3 months of dual antiplatelet therapy and continuing ticagrelor alone reduce clinically relevant bleeding without increasing ischemic events?
- Design
- Double-blind randomized trial that enrolled 9006 patients; 7119 were randomized after completing 3 months of ticagrelor plus aspirin without a major bleeding or ischemic event. Post-randomization follow-up was 1 year.
- Population
- Patients at high risk of bleeding or ischemic events who had undergone PCI and who completed 3 months of ticagrelor plus aspirin without major bleeding or an ischemic event.
- Intervention
- Ticagrelor 90 mg twice daily plus aspirin-matching placebo for 12 months (ticagrelor monotherapy).
- Control
- Ticagrelor 90 mg twice daily plus aspirin 81–100 mg daily for 12 months.
- Primary outcome
- BARC type 2, 3 or 5 bleeding between randomization and 1 year. The composite of all-cause death, nonfatal myocardial infarction or nonfatal stroke was also assessed with a noninferiority hypothesis (absolute margin of 1.6 percentage points).
- Results
- BARC type 2, 3 or 5 bleeding occurred in 4.0% with ticagrelor plus placebo versus 7.1% with ticagrelor plus aspirin (HR 0.56; 95% CI 0.45 to 0.68; P<0.001). The composite of death, myocardial infarction or stroke was 3.9% in both groups (HR 0.99; 95% CI 0.78 to 1.25; P<0.001 for noninferiority).
- Safety
- BARC type 3 or 5 bleeding was 1.0% with monotherapy versus 2.0% with ticagrelor plus aspirin (HR 0.49; 95% CI 0.33 to 0.74).
- Conclusion
- In high-risk patients after PCI who completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy caused less clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction or stroke.
- Why it matters
- It supported the strategy of shortening dual antiplatelet therapy and continuing a P2Y12 inhibitor alone to reduce bleeding in high-risk patients after PCI.
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