Analyzing the Efficacy of Ticagrelor, Clopidogrel Monotherapy Versus DAPT Following PCI

Ticagrelor monotherapy is similarly effective and safer than dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), according to a study published in JAMA Cardiology.

“Among patients undergoing PCI, it remains unclear whether the treatment efficacy of P2Y₁₂ inhibitor monotherapy after a short course of DAPT depends on the type of P2Y₁₂ inhibitor,” researchers said.

They performed a systematic review of the MEDLINE, Embase, TCTMD, and European Society of Cardiology databases and analyzed 6 randomized, clinical trials comprising 25,960 patients. The primary end point of interest was noninferiority of ticagrelor or clopidogrel monotherapy versus DAPT on the composite of death, myocardial infarction (MI), or stroke in the per-protocol analysis, with a 1.15 margin for the hazard ratio. Secondary end points included major bleeding and net adverse clinical events (NACE), including the primary end point and major bleeding.

According to the results, ticagrelor monotherapy was noninferior to DAPT for death, MI, or stroke and superior for major bleeding. The researchers also observed that clopidogrel monotherapy was associated with reduced bleeding but was not noninferior to DAPT for death, MI, or stroke.

“Ticagrelor monotherapy was noninferior to DAPT for all-cause death, MI, or stroke and superior for major bleeding and NACE. Clopidogrel monotherapy was similarly associated with reduced bleeding but was not noninferior to DAPT for all-cause death, MI, or stroke, largely because of risk observed in 1 trial that exclusively included East Asian patients and a hazard that was driven by an excess of noncardiovascular death,” the researchers concluded.