{
  "abstract": "Background\n\nThe 2025 American College of Cardiology/American Heart Association guidelines endorse de-escalation to ticagrelor monotherapy after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACSs), whereas the 2023 European Society of Cardiology guidelines recommend 12-month dual antiplatelet therapy (DAPT) with aspirin plus prasugrel as the default strategy.Objectives\n\nThe objective of the study was to compare ischemic and bleeding outcomes between these strategies and to evaluate whether diabetes modifies their relative effects.Methods\n\nRandomized controlled trials enrolling patients after PCI and evaluating de-escalation to ticagrelor monotherapy or 12-month DAPT (ticagrelor or prasugrel-based) were included. The primary efficacy and safety outcomes were major adverse cardiovascular or cerebrovascular events (MACCE) and major bleeding. Incidence rate ratios (IRRs) with 95% CIs were pooled using a frequentist random-effects network meta-analysis. Subgroup analyses were performed according to diabetes status.Results\n\nSeven randomized controlled trials including 27,225 patients were included (mean age, 62 years; 23.2% women; 31.7% diabetes; 98.6% ACS). Ticagrelor monotherapy and aspirin plus prasugrel were compared indirectly through ticagrelor-based DAPT. Ticagrelor monotherapy showed similar MACCE compared with aspirin plus prasugrel (IRR: 1.09; 95% CI: 0.86-1.38), although a clinically meaningful increase in risk cannot be excluded (P for noninferiority = 0.33); major bleeding was lower with ticagrelor monotherapy (IRR: 0.54; 95% CI: 0.37-0.80). An interaction between P2Y₁₂ inhibitor strategy and diabetes status was observed for MACCE (Pint = 0.04).Conclusions\n\nIn this network meta-analysis of predominantly ACS patients undergoing PCI, ticagrelor monotherapy reduced major bleeding compared with 12 months of aspirin plus prasugrel, whereas it did not meet noninferiority for MACCE. Direct randomized comparisons are warranted. (Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis; CRD420261322968).",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Sant'Andrea Hospital, La Spezia, Italy. Electronic address: michelemaremmani.90@gmail.com.",
    "Department of Cardiology, Campus Bio-Medico University Hospital, Rome, Italy.",
    "Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.",
    "Department of Advanced Biomedical Sciences, University of Naples \"Federico II\", Naples, Italy.",
    "Department of Cardiology, Sant'Andrea Hospital, La Spezia, Italy.",
    "Heart Institute (InCor), Universidade de São Paulo (USP), São Paulo, Brazil.",
    "Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy; A.O.U. Policlinic \"G. Martino\", Messina, Italy.",
    "Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland; Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany.",
    "Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany; Department of Internal Medicine, University of Genoa, Genoa, Italy. Electronic address: Davide.DiVece@med.uni-greifswald.de."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Michele Maremmani"
    },
    {
      "affs": [
        1
      ],
      "name": "Enrico Citerni"
    },
    {
      "affs": [
        2
      ],
      "name": "Ovidio De Filippo"
    },
    {
      "affs": [
        3
      ],
      "name": "Raffaele Piccolo"
    },
    {
      "affs": [
        4
      ],
      "name": "Alberto Menozzi"
    },
    {
      "affs": [
        5
      ],
      "name": "Carlos M Campos"
    },
    {
      "affs": [
        6
      ],
      "name": "Francesco Costa"
    },
    {
      "affs": [
        2
      ],
      "name": "Fabrizio D'Ascenzo"
    },
    {
      "affs": [
        7
      ],
      "name": "Christian Templin"
    },
    {
      "affs": [
        8
      ],
      "name": "Davide Di Vece"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1c85drg91bd0j.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103298",
  "fulltext_url": "https://europepmc.org/articles/PMC13671373",
  "id": "1c85drg91bd0j",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42832923",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Antiplatelet Therapy and Cardiovascular Diseases"
    ]
  ],
  "openalex": "W7220406821",
  "pdf_url": "https://europepmc.org/articles/PMC13671373?pdf=render",
  "pmcid": "PMC13671373",
  "pmid": "42832923",
  "published": "2026-10-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1c85drg91bd0j.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42832923",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42832923"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Antiplatelet Therapy and Cardiovascular Diseases",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis.",
  "title_text": "Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/1c85drg91bd0j",
  "venue": "JACC. Advances",
  "versions": []
}