{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T01:27:41Z","timestamp":1786498061390,"version":"build-2736575974"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"National Key Research and Development Program of China","award":["2022YFC2503503, 2022YFC2503504, and 2024ZD0527502"],"award-info":[{"award-number":["2022YFC2503503, 2022YFC2503504, and 2024ZD0527502"]}]},{"name":"Liaoning Provincial Science and Technology Program Joint Program","award":["2025110377-JH2\/1018 and 2024011669-JH4\/4800"],"award-info":[{"award-number":["2025110377-JH2\/1018 and 2024011669-JH4\/4800"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:p>Patients with acute coronary syndrome (ACS) who have concurrent high ischemic and high bleeding risk are common after percutaneous coronary intervention (PCI), yet evidence guiding P2Y12 inhibitor selection remains limited. We compared ticagrelor and clopidogrel in ACS patients meeting OPT-BIRISK dual high-risk criteria after drug-eluting stent (DES) implantation.<\/jats:p>\n                  <jats:p>We retrospectively analyzed a single-center PCI registry. ACS patients undergoing new-generation DES implantation (March 2019\u2013March 2022) who met both high ischemic and high bleeding risk criteria were classified by discharge P2Y12 inhibitor. Propensity score overlap weighting was adjusted for confounding. The primary endpoint was 12-month net adverse clinical events (NACE): all-cause death, myocardial infarction, stroke, or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding.<\/jats:p>\n                  <jats:p>The final cohort comprised 20,213 dual high-risk patients (ticagrelor, 4,563 [22.6%]; clopidogrel, 15,650 [77.4%]). NACE was similar between groups (4.58% vs. 5.21%; adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 0.89\u20131.23; p\u2009=\u20090.568). Ticagrelor was not associated with reduced ischemic events (aHR, 0.90; 95% CI, 0.72\u20131.12; p\u2009=\u20090.333) but with higher BARC type 3 or 5 bleeding (2.17% vs. 1.57%; aHR, 1.39; 95% CI, 1.08\u20131.77; p\u2009=\u20090.009). In exploratory subgroup analysis, ticagrelor was associated with higher NACE in patients aged 75 years or older (p-Value for interaction\u2009=\u20090.04).<\/jats:p>\n                  <jats:p>In dual high-risk ACS patients undergoing DES implantation, discharge ticagrelor-based dual antiplatelet therapy was associated with higher bleeding risk without reducing NACE or ischemic events compared with clopidogrel. These observational findings support individualized P2Y12 inhibitor selection and warrant prospective confirmation.<\/jats:p>","DOI":"10.1055\/a-2922-8191","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:38:57Z","timestamp":1786495137000},"source":"Crossref","is-referenced-by-count":0,"title":["Ticagrelor versus Clopidogrel in Acute Coronary Syndrome Patients with High Ischemic and Bleeding Risk after Drug-eluting Stent Implantation"],"prefix":"10.1055","author":[{"given":"Kun","family":"Na","sequence":"first","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miaohan","family":"Qiu","sequence":"first","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaling","family":"Han","sequence":"first","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixuan","family":"Duan","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, General Hospital of Northern Theater Command, Liaoning, China","place":["Shenyang"],"department":["Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ahj.2020.07.005","article-title":"Extended antiplatelet therapy with clopidogrel alone versus clopidogrel plus aspirin after completion of 9- to 12-month dual antiplatelet therapy for acute coronary syndrome patients with both high bleeding and ischemic risk. Rationale and design of the OPT-BIRISK double-blinded, placebo-controlled randomized trial","volume":"228","author":"Y Li","year":"2020","journal-title":"Am Heart J"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1001\/jamacardio.2024.0534","article-title":"Extended clopidogrel monotherapy vs DAPT in patients with acute coronary syndromes at high ischemic and bleeding risk: the OPT-BIRISK randomized clinical trial","volume":"9","author":"Y Li","year":"2024","journal-title":"JAMA Cardiol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1201091","DOI":"10.3389\/fcvm.2023.1201091","article-title":"Effect of dual antiplatelet therapy prolongation in acute coronary syndrome patients with both high ischemic and bleeding risk: insight from the OPT-CAD study","volume":"10","author":"K Na","year":"2023","journal-title":"Front Cardiovasc 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