Study Reveals Ticagrelor & Placebo Combination May Reduce Bleeding Risk Post-PCI

Healthcare professionals perform percutaneous coronary intervention (PCI) to treat people with ACS. According to international guidelines, patients should take antiplatelet therapy with Aspirin and a P2Y12 receptor inhibitor together for a year after PCI. Healthcare professionals used to use this dual antiplatelet therapy (DAPT) to prevent heart attack and stent thrombosis. However, there needs to be more data that clarifies how well and safely antiplatelet therapy with Aspirin and a P2Y12 receptor inhibitor works.  

A recent study published in The Lancet journal showed the comparative effectiveness of using ticagrelor, placebo, and Aspirin. It was mainly focused on whether the use of ticagrelor and placebo together reduces the risk of bleeding in patients with ACI after PCI.  

This study was conducted at 58 centres in four countries (Italy, China, the UK and Pakistan) between August 2019 and October 2022. This study involved 3,400 patients with ACS who completed the IVUS-ACS study. These participants were classified into two groups such as the ticagrelor-placebo group consisted of 1700 patients who were asked to stop taking Aspirin and to take ticagrelor and placebo together after a month of their PCI, and the ticagrelor-aspirin group consisted of 1700 patients who continued ticagrelor and Aspirin for a year. This classification was done using a web-based system, diabetes, and IVUS-ACS randomization.  

In this study, researchers observed that the risk of bleeding in the ticagrelor-placebo group was 2.1% and in the ticagrelor-aspirin group was 4.6%. It was easily seen that the risk of bleeding in the ticagrelor-placebo group was reduced by 50% compared to the ticagrelor-aspirin group. However, researchers also noticed that the risk of major adverse cardiovascular or cerebrovascular events (MACCE) such as cardiac death, heart attack, ischemic stroke, and stent thrombosis was the same for both groups. The risk of MACCE in the ticagrelor-placebo group was 3.6%, and the ticagrelor-aspirin group was 3.7%.  

The results of this study show that taking ticagrelor and placebo together is beneficial for patients after PCI. As this treatment helps reduce the risk of bleeding, it will be helpful in treating people with ACS. The data of this study will give healthcare professionals a new way to make effective patient care strategies.  

Reference Link:   

Zhen Ge et al., Ticagrelor alone versus ticagrelor plus Aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomized, placebo-controlled, double-blind clinical trial, The Lancet (2024).   

DOI: 10.1016/S0140-6736(24)00473-2