Ticagrelor monotherapy following short-term DAPT more suitable for seniors with ACS

For older acute coronary syndrome (ACS) patients with implanted bioabsorbable polymer sirolimus-eluting stents, a strategy involving ticagrelor monotherapy after 3‐month dual antiplatelet therapy (DAPT) is better than ticagrelor‐based 12‐month DAPT, according to a post hoc analysis of the TICO* trial. Furthermore, the beneficial effect of ticagrelor monotherapy increases with age and is strongest among patients aged ≥64 years.

TICO trial randomly assigned 3,056 patients (median age 61 years) to the ticagrelor monotherapy after 3‐month DAPT group or ticagrelor‐based 12‐month DAPT group. Researchers used the subpopulation treatment effect pattern plot to assess the age‐dependent effect of the treatment strategies on the primary endpoint (which is a composite of major bleeding, death, myocardial infarction, stent thrombosis, stroke, or target‐vessel revascularization).

Results showed an age‐dependent, gradually increasing benefit with ticagrelor monotherapy after 3‐month DAPT than with ticagrelor‐based 12‐month DAPT for the primary endpoint, and it was more pronounced in the subpopulation of patients aged 64 years and older.

At and above the cutoff age of 64 years (n=1,278), the primary endpoint occurred with significantly less frequency on ticagrelor monotherapy after 3‐month DAPT group than on the ticagrelor‐based 12‐month DAPT (4.4 percent vs 9.0 percent; p=0.002; p_interaction=0.036). The outcome did not differ by treatment among patients aged <64 years (n=1,778).

The findings suggest that ticagrelor monotherapy after short‐term DAPT might be a more suitable antiplatelet strategy than ticagrelor‐based 12‐month DAPT among elderly ACS patients who received implantable bioabsorbable polymer sirolimus‐eluting stents.

*Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus‐eluting Stent for Acute Coronary Syndrome