Comparison of Ticagrelor Monotherapy and Ticagrelor plus Aspirin Among Patients with Acute Coronary Syndrome Combined with High-Risk of Gastrointestinal Bleeding after PCI: a Retrospective Cohort Study.

Abstract

No studies to date have specifically examined the efficacy of P2Y12 inhibitor monotherapy in acute coronary syndrome (ACS) patients exhibiting a high risk of gastrointestinal (GI) bleeding following percutaneous coronary intervention (PCI). This was a retrospective cohort study of ACS exhibiting a high GI bleeding risk after PCI admitted to the Affiliated Hospital of Jiangnan University from August 2016-December 2019. Of the 308 enrolled patients, 269 were found eligible and were assigned to the ticagrelor monotherapy (TIC) arm (n=128) and to ticagrelor plus aspirin(TIC+ASP) arm (n=141) treatment for a 1-year period. The primary study outcome was a composite endpoint including bleeding academic research consortium (BARC) type 2, 3, or 5 bleeding and adverse cardiac or cerebrovascular events. 8 (6.3%) in the TIC group and 14 (9.9%) in the combination treatment group reached the primary ischemic endpoint within 1 year with no significant difference between these groups. BARC type 2/3/5 bleeding events affected significantly more patients in the combination group relative to the TIC group (38[27.0%] vs 11[8.6%], P <0.001). As the follow-up interval was prolonged, the cumulative BARC type 2/3/5 bleeding incidence in the TIC group remained significantly below that in the combination treatment group (P<0.05). These results indicate that TIC is associated with a lower risk of clinically relevant bleeding events among ACS with a high risk of GI bleeding after PCI relative to combination TIC+ASP treatment, while ischemic outcomes in these two groups were similar.