• NEWS . 22 May 2020
  • Ticagrelor monotherapy benefits post-PCI in ACS patients: TICO trial

  • In patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), ticagrelor monotherapy after 3 months of dual antiplatelet therapy (DAPT) was superior at preventing ischaemia and bleeding with no increase in adverse cardiovascular events, according to the TICO trial. 

    In what the authors say is the first randomized study to compare ticagrelor monotherapy after 3 months of DAPT against standard 12-month DAPT in ACS, a total of 3,056 patients with ACS at 38 centres in South Korea between August 2015 and October 2018 were enrolled. Patients were randomized to ticagrelor monotherapy after 3 months of DAPT (n=1,527) or standard therapy (n=1,529). Their average age was 61 years, 79% were men and 27% had diabetes. 

    Results showed that net adverse clinical events (death, myocardial infarction, stent thrombosis, stroke or target vessel revascularization) at 12 months occurred in 3.9% of the ticagrelor monotherapy after 3 months of DAPT group vs 5.9% of the standard therapy group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.48–0.92; p=0.01). This difference was driven by a reduction in bleeding risk in the ticagrelor monotherapy vs standard therapy group (1.7% vs 3%; HR, 0.56; 95% CI, 0.34–0.91; p=0.02).

    Based on these findings, the researchers concluded that ticagrelor monotherapy could be an effective strategy for preventing ischaemic and bleeding events without increasing the risk of adverse cardiac events. 

    Kim, BK. Ticagrelor With or Without Aspirin in Acute Coronary Syndrome After PCI –TICO. Presented at: American College of Cardiology Virtual Annual Scientific Session Together With World Congress of Cardiology (ACC 2020/WCC); March 30 2020.