Predictors of main bleeding following ticagrelor

In patients with acute coronary syndrome who underwent coronary stent implantation, the incidence of major bleeding after ticagrelor therapy is associated with low body weight, anaemia, and chronic kidney disease, a study reports.

The analysis included a total of 2,660 patients who participated in the TICO (Ticagrelor Monotherapy After 3 Months in Patients Treated With New Generation Sirolimus‐Eluting Stent for Acute Coronary Syndrome) randomized trial.

Researchers identified clinical and procedural factors related to major bleeding—defined by TIMI (Thrombolysis in Myocardial Infarction) major or Bleeding Academic Research Consortium type 3 or 5—by comparing patients who did with those who did not experience the outcome.

Multiple risk factors for the risk of major bleeding emerged on multivariable and receiver operating characteristic curve analyses. Specifically, weight ≤65 kg, haemoglobin ≤12 g/dL, and estimated glomerular filtration rate <60 mL/min per 1.73 m² were associated with a risk increase.

Conversely, 3‐month aspirin therapy with continued ticagrelor, as opposed to 12‐month aspirin and ticagrelor, exerted a protective effect on the risk of major bleeding.

The beneficial effect of 3‐month aspirin therapy on a net adverse clinical event (a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events) remained consistent for patients with any of the said risk factors (hazard ratio, 0.59, 95 percent confidence interval, 0.39–0.90; p_interaction=0.74).

The findings suggest that patients with a bleeding risk may achieve better outcomes with early aspirin discontinuation.