Ticagrelor with or without aspirin in high-risk patients with anaemia undergoing percutaneous coronary intervention: a subgroup analysis of the TWILIGHT trial.

Spirito, Alessandro; Kastrati, Adnan; Cao, Davide; Baber, Usman; Sartori, Samantha; Angiolillo, Dominick J; Briguori, Carlo; Cohen, David J; Dangas, George; Dudek, Dariusz; Escaned, Javier; Gibson, C Michael; Zhang, Zhongjie; Huber, Kurt; Kaul, Upendra; Kornowski, Ran; Kunadian, Vijay; Han, Ya-Ling; Mehta, Shamir R; Sardella, Gennaro; Sharma, Samin; Shlofmitz, Richard A; Vogel, Birgit; Collier, Timothy; Pocock, Stuart; Mehran, Roxana

doi:10.1093/ehjcvp/pvad006

journal article

Titel:: Ticagrelor with or without aspirin in high-risk patients with anaemia undergoing percutaneous coronary intervention: a subgroup analysis of the TWILIGHT trial.
Dokumenttyp:: Randomized Controlled Trial; Journal Article; Research Support, Non-U.S. Gov't
Autor(en):: Spirito, Alessandro; Kastrati, Adnan; Cao, Davide; Baber, Usman; Sartori, Samantha; Angiolillo, Dominick J; Briguori, Carlo; Cohen, David J; Dangas, George; Dudek, Dariusz; Escaned, Javier; Gibson, C Michael; Zhang, Zhongjie; Huber, Kurt; Kaul, Upendra; Kornowski, Ran; Kunadian, Vijay; Han, Ya-Ling; Mehta, Shamir R; Sardella, Gennaro; Sharma, Samin; Shlofmitz, Richard A; Vogel, Birgit; Collier, Timothy; Pocock, Stuart; Mehran, Roxana
Abstract:: AIM: The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anaemia undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: In the TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. The key secondary endpoint was a composite of all-cause death, myocardial infarction, or stroke.Out of 6828 patients, 1329 (19.5%) had anaemia and were more likely to have comorbidities, multivessel disease, and to experience bleeding or ischaemic complications than non-anaemic patients. Among anaemic patients, BARC 2, 3, or 5 bleeding occurred less frequently with ticagrelor monotherapy than with ticagrelor plus aspirin [6.4% vs. 10.7%; hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.41-0.88; P = 0.009]; the rate of the key secondary endpoint was similar in the two arms (5.2% vs. 4.8%; HR 1.07; 95% CI 0.66-1.74; P = 0.779). These effects were consistent in patients without anaemia (interaction P values 0.671 and 0.835, respectively). CONCLUSION: In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a reduced risk of clinically relevant bleeding without any increase in ischaemic events irrespective of anaemia status (TWILIGHT: NCT02270242).
Zeitschriftentitel:: Eur Heart J Cardiovasc Pharmacother
Jahr:: 2023
Band / Volume:: 9
Heft / Issue:: 4
Seitenangaben Beitrag:: 328-336
Volltext / DOI:: doi:10.1093/ehjcvp/pvad006
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/36649694
Print-ISSN:: 2055-6837
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2023