• NEWS . 14 Oct 2019
  • Aspirin may be removed from DAPT after 1 month

  • Patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) and are then given ticagrelor plus aspirin may not need aspirin after a month of dual antiplatelet therapy. This is according to a post hoc analysis of the GLOBAL LEADERS trial, a randomized, open-label superiority trial comparing two antiplatelet treatment strategies after PCI in 15,991 unselected patients with stable coronary artery disease or ACS undergoing PCI. Patients taking ticagrelor alone versus ticagrelor plus aspirin from 1 to 12 months had less bleeding and similar ischaemic risk.

    The post hoc analysis included 7,487 patients with ACS: 3,750 patients were assigned to the experimental group and 3,737 patients to the reference group. Between 1 and 12 months after PCI in ACS, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischaemic events. Between 1 and 12 months after randomization, the primary outcome (ie, the composite of all-cause death or new Q-wave myocardial infarction) occurred in 55 patients (1.5%) in the experimental group and in 75 patients (2.0%) in the reference group (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.51–1.03; p=0.07); investigator-reported Bleeding Academic Research Consortium-defined bleeding type 3 or 5 occurred in 28 patients (0.8%) in the experimental group and in 54 patients (1.5%) in the reference arm (HR, 0.52; 95% CI, 0.33–0.81; p=0.004).

    Dr Mariusz Tomaniak of the Erasmus Medical Center in Rotterdam, the Netherlands, who led the post hoc study said these findings should be interpreted as exploratory and hypothesis generating. However, they may pave the way for further trials evaluating aspirin-free antiplatelet strategies after PCI.

    Tomaniak M, et al. Benefit and risks of aspirin in addition to ticagrelor in acute coronary syndromes: a post hoc analysis of the randomized GLOBAL LEADERS trial. JAMA Cardiol 2019 Sep 26 [Epub ahead of print].