Ticagrelor monotherapy as safe, effective as aspirin post-CABG

Among patients who have undergone coronary artery bypass grafting (CABG), treatment with ticagrelor achieves comparable 1-year efficacy and safety as aspirin, reports a recent study.

Researchers conducted a pre-specific subanalysis of the TiCAB trial, a placebo-controlled, randomized study comparing aspirin vs placebo against ticagrelor vs placebo. The present analysis included 280 women and 1,579 men who were followed up 1 year after CABG to assess the primary efficacy endpoint of a composite of cardiovascular death, myocardial infarction, stroke, or repeat revascularization.

The incidence of the primary endpoint was comparable between men and women (9.2 percent vs 8.9 percent; hazard ratio [HR], 1.08, 95 percent confidence interval [CI], 0.71–1.66; p=0.71).

Similarly, treatment with ticagrelor led to a comparable 1-year risk of the primary outcome as aspirin both in women (10.6 percent vs 7.9 percent; HR, 1.39, 95 percent CI, 0.63–3.05; p=0.42) and men (9.5 percent vs 8.2 percent; HR, 1.15, 95 percent CI, 0.82–1.52; p=0.41).

Bleeding likewise had similar incidences in both sexes (2.2 percent vs 2.5 percent in women and men, respectively; HR, 0.91, 95 percent CI, 0.51–1.65; p=0.77).

Ticagrelor use also yielded a similar risk of bleeding as aspirin in women (2.9 percent vs 1.4 percent; HR, 2.09, 95 percent CI, 0.38–11.41; p=0.40) and men (2.2 percent vs 2.8 percent; HR, 0.80, 95 percent CI, 0.42–1.52; p=0.49).

“A greater representation of women in randomized controlled trials is paramount to adequately provide evidence for optimal antiplatelet therapy in women after CABG,” the researchers said.