TiCAB: No Additional Benefit from Ticagrelor Monotherapy vs. Aspirin in CABG Patients

Ticagrelor monotherapy did not yield an additional benefit for cardiovascular events or in terms of bleeding compared to aspirin monotherapy in patients undergoing coronary artery bypass graft (CABG), new study results presented at the American Heart Association 2018 Scientific Sessions suggested.

Researchers for the Ticagrelor versus Aspirin in Patients Undergoing Coronary Bypass Surgery (TiCAB) trial, seeking to clarify the balance between bleeding and thrombotic risks with antiplatelet treatment strategy in CABG patients, randomly assigned patients scheduled for CABG (1:1) to receive either 100 mg aspirin once daily or ticagrelor 90 mg twice daily. The primary study outcome was a composite of cardiovascular death, myocardial infarction, repeat revascularization, and stroke at one year post-CABG. The primary safety endpoint was major bleeding.

According to the study results, the primary study endpoint occurred in 7.9% of patients in the aspirin group and 9.2% of patients in the ticagrelor group (HR=1.19; 95% CI, 0.87 to 1.62; P=0.27). Additionally, all-cause (aspirin 2.5% vs. ticagrelor 2.4%; HR=0.96, CI 0.53 to 1.72; P=0.89) and cardiovascular mortality (aspirin 1.40% vs. ticagrelor 1.18%; HR=0.85, CI 0.38 to 1.89; P=0.68) was similar between study groups. There were no differences in the individual components of the primary study outcomes between groups, and no differences in bleeding rates.

Study presenter and lead author Heribert Schunkert, MD, of the German Heart Center of Munich in Germany, noted in the study limitations portion of his presentation that the study was terminated early due to recruiting only half of anticipated patients, and after ticagrelor displayed no signal for better outcomes.

Discussant Robert F. Storey, MD, of the University of Sheffield in the United Kingdom, said in his presentation that the TiCAB results “add to a larger body of evidence indicating noninferiority and a lack of superiority of ticagrelor monotherapy compared to aspirin monotherapy in patients with coronary artery disease or ischemic stroke/transient ischemic attack.”

Read the study abstract here.