Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis.
9 affiliations
- 1Department of Cardiology, Sant'Andrea Hospital, La Spezia, Italy. Electronic address: [email protected].
- 2Department of Cardiology, Campus Bio-Medico University Hospital, Rome, Italy.
- 3Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
- 4Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
- 5Department of Cardiology, Sant'Andrea Hospital, La Spezia, Italy.
- 6Heart Institute (InCor), Universidade de São Paulo (USP), São Paulo, Brazil.
- 7Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy; A.O.U. Policlinic "G. Martino", Messina, Italy.
- 8Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland; Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany.
- 9Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany; Department of Internal Medicine, University of Genoa, Genoa, Italy. Electronic address: [email protected].
Abstract
Background
The 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
The objective of the study was to compare ischemic and bleeding outcomes between these strategies and to evaluate whether diabetes modifies their relative effects.Methods
Randomized 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
Seven 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
In 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).
Related
- Efficacy and Safety of Prasugrel, Ticagrelor, or Clopidogrel After Percutaneous Coronary Intervention
- Ticagrelor versus prasugrel following PCI in acute coronary syndromes and high-risk coronary artery disease: A meta-analysis of one-year randomized trial outcomes
- Aspirin vs. Clopidogrel Monotherapy Beyond 1 Month After Percutaneous Coronary Intervention in Patients With Diabetes ― Prespecified Subgroup Analysis of the STOPDAPT-3 Trial ―
- Antiplatelet monotherapy maintenance strategies after percutaneous coronary intervention in patients with coronary artery disease at high bleeding risk: a network meta-analysis
- Deep dynamic coronary roadmap guidance in percutaneous coronary intervention: a deep learning approach
BibTeX
@article{maremmani2026ticagrelor,
title = {{Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis.}},
author = {Michele Maremmani and Enrico Citerni and Ovidio De Filippo and Raffaele Piccolo and Alberto Menozzi and Carlos M Campos and Francesco Costa and Fabrizio D'Ascenzo and Christian Templin and Davide Di Vece},
journal = {JACC. Advances},
year = {2026},
month = oct,
doi = {10.1016/j.jacadv.2026.103298},
url = {https://europepmc.org/article/MED/42832923},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ticagrelor Monotherapy or Aspirin Plus Prasugrel After Percutaneous Coronary Intervention: A Network Meta-Analysis.
AU - Michele Maremmani
AU - Enrico Citerni
AU - Ovidio De Filippo
AU - Raffaele Piccolo
AU - Alberto Menozzi
AU - Carlos M Campos
AU - Francesco Costa
AU - Fabrizio D'Ascenzo
AU - Christian Templin
AU - Davide Di Vece
PY - 2026
DA - 2026/10/05
JO - JACC. Advances
DO - 10.1016/j.jacadv.2026.103298
UR - https://europepmc.org/article/MED/42832923
AB - Background The 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 The objective of the study was to compare ischemic and bleeding outcomes between these strategies and to evaluate whether diabetes modifies their relative effects.Methods Randomized 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 Seven 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 In 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).
SN - 2772-963X
ER -