{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:44:10Z","timestamp":1792827850182,"version":"4.5.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/100021316","name":"AstraZeneca United States","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100021316","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,2,20]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>\n              Dual antiplatelet therapy with a potent P2Y\n              <jats:sub>12<\/jats:sub>\n              inhibitor coupled with aspirin for 1 year is the recommended treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). As an alternative, monotherapy with a P2Y\n              <jats:sub>12<\/jats:sub>\n              inhibitor after a short period of dual antiplatelet therapy has emerged as a bleeding reduction strategy.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We pooled individual patient data from randomized trials that included patients with ACS undergoing PCI treated with an initial 3-month course of dual antiplatelet therapy followed by ticagrelor monotherapy versus continued ticagrelor plus aspirin. Patients sustaining a major ischemic or bleeding event in the first 3 months after PCI were excluded from analysis. The primary outcome was Bleeding Academic Research Consortium type 3 or 5 bleeding occurring between 3 and 12 months after index PCI. The key secondary end point was the composite of death, myocardial infarction, or stroke. Hazard ratios and 95% CIs were generated using Cox regression with a one-stage approach in the intention-to-treat population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The pooled cohort (n=7529) had a mean age of 62.8 years, 23.2% were female, and 55% presented with biomarker-positive ACS. Between 3 and 12 months, ticagrelor monotherapy significantly reduced Bleeding Academic Research Consortium 3 or 5 bleeding compared with ticagrelor plus aspirin (0.8% versus 2.1%; hazard ratio, 0.37 [95% CI, 0.24\u20130.56];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). Rates of all-cause death, myocardial infarction, or stroke were not significantly different between groups (2.4% versus 2.7%; hazard ratio, 0.91 [95% CI, 0.68\u20131.21];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.515). Findings were unchanged among patients presenting with biomarker-positive ACS.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Among patients with ACS undergoing PCI who have completed a 3-month course of dual antiplatelet therapy, discontinuation of aspirin followed by ticagrelor monotherapy significantly reduced major bleeding without incremental ischemic risk compared with ticagrelor plus aspirin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\">https:\/\/www.crd.york.ac.uk\/prospero<\/jats:ext-link>\n              ; Unique identifier: CRD42023449646.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.123.067283","type":"journal-article","created":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T16:30:12Z","timestamp":1698078612000},"page":"574-584","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Safety and Efficacy of Ticagrelor Monotherapy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An Individual Patient Data Meta-Analysis of TWILIGHT and TICO Randomized Trials"],"prefix":"10.1161","volume":"149","author":[{"given":"Usman","family":"Baber","sequence":"first","affiliation":[{"name":"Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (U.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2169-3112","authenticated-orcid":true,"given":"Yangsoo","family":"Jang","sequence":"additional","affiliation":[{"name":"Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, South Korea (Y.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0561-7563","authenticated-orcid":true,"given":"Angelo","family":"Oliva","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy (A.O., D.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7755-4069","authenticated-orcid":true,"given":"Davide","family":"Cao","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy (A.O., D.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9896-403X","authenticated-orcid":true,"given":"Birgit","family":"Vogel","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7502-8049","authenticated-orcid":true,"given":"George","family":"Dangas","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0618-9409","authenticated-orcid":true,"given":"Samantha","family":"Sartori","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Spirito","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2646-1933","authenticated-orcid":true,"given":"Kenneth F.","family":"Smith","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8063-7882","authenticated-orcid":true,"given":"Mattia","family":"Branca","sequence":"additional","affiliation":[{"name":"CTU Bern, University of Bern, Switzerland (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3095-277X","authenticated-orcid":true,"given":"Timothy","family":"Collier","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK (T.C., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2212-4007","authenticated-orcid":true,"given":"Stuart","family":"Pocock","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK (T.C., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4353-7110","authenticated-orcid":true,"given":"Marco","family":"Valgimigli","sequence":"additional","affiliation":[{"name":"Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland (M.V.)."},{"name":"Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (M.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2493-066X","authenticated-orcid":true,"given":"Byeong-Keuk","family":"Kim","sequence":"additional","affiliation":[{"name":"Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.-K.K., M.-K.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-2031","authenticated-orcid":true,"given":"Myeong-Ki","family":"Hong","sequence":"additional","affiliation":[{"name":"Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (B.-K.K., M.-K.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-262X","authenticated-orcid":true,"given":"Roxana","family":"Mehran","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.O., D.C., B.V., G.D., S.S., A.S., K.F.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001038"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0783"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024835"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.01.029"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.04.009"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61720-1"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw525"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-01197"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.7580"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.5244"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa670"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015560"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa739"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046251"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1332"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.040167"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1599"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61782-1"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-00145"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908419"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.04160.x"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.11.056"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31858-0"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30397-5"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2021.07.016"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2108749"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064473"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvab068"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31791-8"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.03.008"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.03.011"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-21-00721"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.123.067283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T22:48:03Z","timestamp":1748472483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.123.067283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,2,20]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.123.067283"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.123.067283","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"assertion":[{"value":"2023-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}