Ticagrelor with or without aspirin in high-risk patients with anaemia undergoing percutaneous coronary intervention: a subgroup analysis of the TWILIGHT trial

Alessandro Spirito, Adnan Kastrati, Davide Cao, Usman Baber, Samantha Sartori, Dominick J. Angiolillo, Carlo Briguori, David J. Cohen, George Dangas, Dariusz Dudek, Javier Escaned, C. Michael Gibson, Zhongjie Zhang, Kurt Huber, Upendra Kaul, Ran Kornowski, Vijay Kunadian, Ya Ling Han, Shamir R. Mehta, Gennaro SardellaSamin Sharma, Richard A. Shlofmitz, Birgit Vogel, Timothy Collier, Stuart Pocock, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

Abstract

Aim The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anaemia undergoing percutaneous coronary intervention (PCI). Methods and results In the TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. The key secondary endpoint was a composite of all-cause death, myocardial infarction, or stroke. Out of 6828 patients, 1329 (19.5%) had anaemia and were more likely to have comorbidities, multivessel disease, and to experience bleeding or ischaemic complications than non-anaemic patients. Among anaemic patients, BARC 2, 3, or 5 bleeding occurred less frequently with ticagrelor monotherapy than with ticagrelor plus aspirin [6.4% vs. 10.7%; hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.41–0.88; P = 0.009]; the rate of the key secondary endpoint was similar in the two arms (5.2% vs. 4.8%; HR 1.07; 95% CI 0.66–1.74; P = 0.779). These effects were consistent in patients without anaemia (interaction P values 0.671 and 0.835, respectively). Conclusion In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a reduced risk of clinically relevant bleeding without any increase in ischaemic events irrespective of anaemia status (TWILIGHT: NCT02270242).

Original languageEnglish
Pages (from-to)328-336
Number of pages9
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Volume9
Issue number4
DOIs
StatePublished - 1 Jun 2023

Keywords

  • Anaemia
  • Bleeding
  • Outcomes
  • Percutaneous coronary intervention
  • Ticagrelor monotherapy

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