Ticagrelor Monotherapy vs. Ticagrelor With Aspirin in Bleeding and Cardiovascular Events in Acute Coronary Syndrome Patients According to Renal Function: The Subanalysis From the TICO Trial

Abstract

Background and Objectives Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) has not been established in chronic kidney disease (CKD) patients. This study evaluated the effects of ticagrelor monotherapy after 3-month of DAPT on renal function in acute coronary syndrome patients.

Methods From the TICO trial, the primary outcome was a composite of net adverse clinical events (NACEs), defined as a composite of major bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs). The secondary outcomes were thrombolysis in myocardial infarction (TIMI) major or minor bleeding and MACCE.

Results Among patients without CKD (n=2,436), ticagrelor monotherapy after 3 months of DAPT had a lower rate of NACE (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.21–0.78; p=0.007) and TIMI bleeding (HR, 0.86; 95% CI, 0.19–0.81; p=0.011) than those of ticagrelor-based 12-month DAPT. Among CKD patients receiving ticagrelor monotherapy, lower risk of NACE (HR, 0.45; 95% CI, 0.20–1.02; p=0.055) and bleeding (HR, 0.20; 95% CI, 0.06–0.68; p=0.009) were observed. Otherwise, ticagrelor monotherapy was not significantly associated with an increased MACCE risk in those without CKD (HR, 0.62; 95% CI, 0.30–1.27; p=0.192) or with CKD (HR, 0.55; 95% CI, 0.21–1.48; p=0.237), versus 12-month DAPT.

Conclusions Regardless of renal function, ticagrelor monotherapy after 3 months of DAPT resulted in a reduced risk of not only NACE but also major or minor bleeding at 1 year compared with ticagrelor-based 12-month DAPT. Irrespective of renal function status, however, the MACCE risk was not significantly different between the two strategies.