• NEWS . 25 May 2020
  • Ticagrelor monotherapy vs ticagrelor plus aspirin after complex PCI: the TWILIGHT-COMPLEX analysis

  • Ticagrelor monotherapy has been shown to attenuate bleeding complications without increasing ischaemic risk in patients undergoing complex percutaneous coronary intervention (PCI). A recent study has been carried out to evaluate the effect in patients undergoing complex PCI. The TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) is a randomized, double-blind, placebo-controlled trial comparing ticagrelor monotherapy and ticagrelor plus aspirin. 

    In the TWILIGHT trial, event-free patients who had received 3 months of ticagrelor plus aspirin remained on ticagrelor and were randomized to receive either aspirin or placebo for 1 year. Patients who underwent PCI with any of the following conditions were classified as complex PCI: three vessels treated, ≥3 lesions treated, total stent length >60 mm, bifurcation with two stents implemented, atherectomy device use, left main PCI, surgical bypass graft or chronic total occlusion as target lesions. 

    After 1 year of receiving treatment, eligible patients (n=2,342) were included in the bleeding and ischaemic endpoint evaluations. Compared with ticagrelor plus aspirin, ticagrelor plus placebo resulted in significantly lower rates of Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding (4.2% vs 7.7%; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.38–0.76). BARC type 3 or 5 bleeding was also significantly reduced (1.1% vs 2.6%; HR, 0.41; 95% CI, 0.21–0.80). There were no significant between-group differences in death, myocardial infarction or stroke (3.8% vs 4.9%; HR, 0.77; 95% CI, 0.52–1.15), nor in stent thrombosis.

    To conclude, ticagrelor monotherapy was associated with reduced incidence of bleeding without increasing ischaemic risk among patients undergoing complex PCI who completed 3 months of ticagrelor plus aspirin in advance. 

    Dangas G, et al. Ticagrelor with aspirin or alone after complex PCI: the TWILIGHT-COMPLEX analysis. J Am Coll Cardiol 2020. doi: 10.1016/j.jacc.2020.03.011. [Epub ahead of print]