TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention
A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Pati...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Radcliffe Medical Media
2020-05-01
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| Series: | US Cardiology Review |
| Online Access: | https://www.uscjournal.com/articleindex/usc.2019.02 |
| _version_ | 1797200090413137920 |
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| author | Johny Nicolas Usman Baber Roxana Mehran |
| author_facet | Johny Nicolas Usman Baber Roxana Mehran |
| author_sort | Johny Nicolas |
| collection | DOAJ |
| description | A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke. |
| first_indexed | 2024-03-07T17:40:31Z |
| format | Article |
| id | doaj.art-00b68501fcf04b64ab484ff925adf97a |
| institution | Directory Open Access Journal |
| issn | 1758-3896 1758-390X |
| language | English |
| last_indexed | 2024-04-24T07:26:07Z |
| publishDate | 2020-05-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | US Cardiology Review |
| spelling | doaj.art-00b68501fcf04b64ab484ff925adf97a2024-04-20T16:01:42ZengRadcliffe Medical MediaUS Cardiology Review1758-38961758-390X2020-05-011410.15420/usc.2019.02TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary InterventionJohny Nicolas0Usman Baber1Roxana Mehran2The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NYThe Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NYThe Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NYA P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.https://www.uscjournal.com/articleindex/usc.2019.02 |
| spellingShingle | Johny Nicolas Usman Baber Roxana Mehran TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention US Cardiology Review |
| title | TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention |
| title_full | TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention |
| title_fullStr | TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention |
| title_full_unstemmed | TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention |
| title_short | TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention |
| title_sort | twilight a randomized trial of ticagrelor monotherapy versus ticagrelor plus aspirin beginning at 3 months in high risk patients undergoing percutaneous coronary intervention |
| url | https://www.uscjournal.com/articleindex/usc.2019.02 |
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