{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:52:29Z","timestamp":1781646749174,"version":"3.54.5"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atherosclerotic cardiovascular disease (ASCVD) represents the primary cause of morbidity and mortality among cases with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine whether a strategy of ticagrelor monotherapy initiated after 3 months of dual antiplatelet treatment (DAPT) modifies the rate of major adverse cardiovascular effect (MACE) as the primary endpoint and bleeding events as the secondary endpoint, relative to a 12-month regimen of ticagrelor-based DAPT in diabetic cases with acute coronary syndrome (ACS) treated by Percutaneous coronary intervention (PCI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This randomized, open-label study included 400 diabetic patients with acute coronary syndrome (STEMI or NSTEMI) treated with PCI. Patients were randomly assigned to receive ticagrelor monotherapy after 3 months of DAPT or to continue ticagrelor plus aspirin for 12 months. The primary endpoint was major adverse cardiovascular events (MACE), and the secondary endpoint was bleeding events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hemoglobin level after three month was substantially higher in group 1, the mean\u2009\u00b1\u2009SD was 12.97\u2009\u00b1\u20091.7\u00a0g\/dl while group 2 was 12.6\u2009\u00b1\u20091.47\u00a0g\/dl (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Platelet count did not differ markedly between groups. Similarly, the incidence of complications\u2014mortality, chest pain, bleeding, ICH, ischemic stroke, recurrent MI, and repeated PCI\u2014showed no significant variation between them. There was no significant difference in the incidence of MACE between the two groups during 12 months of follow-up. Ticagrelor monotherapy was associated with a lower incidence of overall bleeding events, mainly driven by reductions in mild bleeding, while rates of moderate or severe bleeding were comparable between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Switching to ticagrelor monotherapy after 3 months of DAPT results in a significant reduction in bleeding events among diabetic cases with ACS undergoing PCI, while maintaining a comparable safety profile regarding complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Pan African Clinical Trials Registry (PACTR202511832264697) Date of registration 24 November 2025.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-05708-w","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:35:45Z","timestamp":1774600545000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of safety and affection of variable duration of dual antiplatelet therapy using aspirin plus ticagrelor after successful percutaneous coronary intervention for diabetic patients with acute coronary syndrome"],"prefix":"10.1186","volume":"26","author":[{"given":"Nour Eldeen Mahmoud Shabaan","family":"Ibrahim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Tarek Mounir","family":"Zaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Ahmed Fouad","family":"Abdel Magid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Ahmed","family":"Fouad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina Magued Abdalla","family":"Iskandar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"5708_CR1","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1007\/s11239-017-1473-5","volume":"43","author":"Z Zhang","year":"2017","unstructured":"Zhang Z, Zhai Z, Yang Y, Wan J, Xie W, Zhu J, et al. Diabetes mellitus is associated with increased bleeding in pulmonary embolism receiving conventional anticoagulant therapy: findings from a real-world study. J Thromb Thrombolysis. 2017;43:540\u20139. https:\/\/doi.org\/10.1007\/s11239-017-1473-5.","journal-title":"J Thromb Thrombolysis"},{"key":"5708_CR2","doi-asserted-by":"publisher","first-page":"682","DOI":"10.18535\/cmhrj.v3i6.276","volume":"3","author":"M Abdelbaki","year":"2023","unstructured":"Abdelbaki M, Khellafi N. Rectal Hemorrhage Revealing Rectal Cancer After Anticoagulation in A Patient with Acute Coronary Syndrome. Clin Med Health Res J. 2023;3:682\u20134. https:\/\/doi.org\/10.18535\/cmhrj.v3i6.276.","journal-title":"Clin Med Health Res J"},{"key":"5708_CR3","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1093\/eurheartj\/ehw525","volume":"38","author":"M Valgimigli","year":"2017","unstructured":"Valgimigli M, Costa F, Lokhnygina Y, Clare RM, Wallentin L, Moliterno DJ, et al. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial. Eur Heart J. 2017;38:804\u201310. https:\/\/doi.org\/10.1093\/eurheartj\/ehw525.","journal-title":"Eur Heart J"},{"key":"5708_CR4","doi-asserted-by":"publisher","first-page":"e3874","DOI":"10.7759\/cureus.3874","volume":"11","author":"M Alomari","year":"2019","unstructured":"Alomari M, Bratton H, Musmar A, Al Momani LA, Young M. Ticagrelor-induced Diarrhea in a Patient with Acute Coronary Syndrome Requiring Percutaneous Coronary Artery Intervention. Cureus. 2019;11:e3874. https:\/\/doi.org\/10.7759\/cureus.3874.","journal-title":"Cureus"},{"key":"5708_CR5","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1056\/NEJMoa1908419","volume":"381","author":"R Mehran","year":"2019","unstructured":"Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med. 2019;381:2032\u201342. https:\/\/doi.org\/10.1056\/NEJMoa1908419.","journal-title":"N Engl J Med"},{"key":"5708_CR6","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.jcin.2020.11.036","volume":"14","author":"SJ Lee","year":"2021","unstructured":"Lee SJ, Cho JY, Kim BK, Yun KH, Suh Y, Cho YH, et al. Ticagrelor Monotherapy Versus Ticagrelor With Aspirin in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2021;14:431\u201340. https:\/\/doi.org\/10.1016\/j.jcin.2020.11.036.","journal-title":"JACC Cardiovasc Interv"},{"key":"5708_CR7","doi-asserted-by":"publisher","unstructured":"Han Y, Claessen BE, Chen SL, Chunguang Q, Zhou Y, Xu Y, et al. (2022) Ticagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China Substudy. Circ Cardiovasc Interv 15:e009495. https:\/\/doi.org\/10.1161\/circinterventions.120.009495","DOI":"10.1161\/circinterventions.120.009495"},{"key":"5708_CR8","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/s11239-019-01997-5","volume":"49","author":"M Osman","year":"2020","unstructured":"Osman M, Farjo PD, Osman K, Radaideh Q, Munir MB, Kheiri B, et al. The dawn of aspirin free strategy after short term dual antiplatelet for percutaneous coronary intervention: meta-analysis of randomized controlled trials. J Thromb Thrombolysis. 2020;49:184\u201391. https:\/\/doi.org\/10.1007\/s11239-019-01997-5.","journal-title":"J Thromb Thrombolysis"},{"key":"5708_CR9","doi-asserted-by":"publisher","first-page":"324","DOI":"10.4070\/kcj.2021.0321","volume":"52","author":"YJ Lee","year":"2022","unstructured":"Lee YJ, Suh Y, Kim JS, Cho YH, Yun KH, Kim YH, et al. Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial. Korean Circ J. 2022;52:324\u201337. https:\/\/doi.org\/10.4070\/kcj.2021.0321.","journal-title":"Korean Circ J"},{"key":"5708_CR10","doi-asserted-by":"publisher","first-page":"e1309","DOI":"10.7759\/cureus.1309","volume":"9","author":"I Anjum","year":"2017","unstructured":"Anjum I, Khan MA, Aadil M, Faraz A, Farooqui M, Hashmi A. Transradial vs. Transfemoral Approach in Cardiac Catheterization: A Literature Review. Cureus. 2017;9:e1309. https:\/\/doi.org\/10.7759\/cureus.1309.","journal-title":"Cureus"},{"key":"5708_CR11","doi-asserted-by":"publisher","first-page":"351","DOI":"10.3109\/09537104.2015.1107536","volume":"27","author":"JJ van Diemen","year":"2016","unstructured":"van Diemen JJ, Fuijkschot WW, Wessels TJ, Veen G, Smulders YM, Thijs A. Evening intake of aspirin is associated with a more stable 24-h platelet inhibition compared to morning intake: a study in chronic aspirin users. Platelets. 2016;27:351\u20136. https:\/\/doi.org\/10.3109\/09537104.2015.1107536.","journal-title":"Platelets"},{"key":"5708_CR12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s13300-022-01350-9","volume":"14","author":"H Wang","year":"2023","unstructured":"Wang H, Xie X, Zu Q, Lu M, Chen R, Yang Z, et al. Treatment of the New Era: Long-Term Ticagrelor Monotherapy for the Treatment of Patients with Type 2 Diabetes Mellitus following Percutaneous Coronary Intervention: A Meta-analysis. Diabetes Ther. 2023;14:47\u201361. https:\/\/doi.org\/10.1007\/s13300-022-01350-9.","journal-title":"Diabetes Ther"},{"key":"5708_CR13","doi-asserted-by":"publisher","first-page":"e1051","DOI":"10.4244\/eij-d-24-00992","volume":"21","author":"DS Castiello","year":"2025","unstructured":"Castiello DS, Oliva A, And\u00f2 G, Niccoli G, Pelliccia F, Moscarella E, et al. Antithrombotic therapy in complex percutaneous coronary intervention. EuroIntervention. 2025;21:e1051\u201368. https:\/\/doi.org\/10.4244\/eij-d-24-00992.","journal-title":"EuroIntervention"},{"key":"5708_CR14","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.iccl.2024.07.001","volume":"13","author":"L Manzi","year":"2024","unstructured":"Manzi L, Florimonte D, Forzano I, Buongiorno F, Sperandeo L, Castiello DS, et al. Antiplatelet Therapy in Patients Requiring Oral Anticoagulation and Undergoing Percutaneous Coronary Intervention. Interv Cardiol Clin. 2024;13:527\u201341. https:\/\/doi.org\/10.1016\/j.iccl.2024.07.001.","journal-title":"Interv Cardiol Clin"},{"key":"5708_CR15","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1161\/circulationaha.120.046251","volume":"142","author":"ML O\u2019Donoghue","year":"2020","unstructured":"O\u2019Donoghue ML, Murphy SA, Sabatine MS. The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y(12) Inhibitor in Patients After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Circulation. 2020;142:538\u201345. https:\/\/doi.org\/10.1161\/circulationaha.120.046251.","journal-title":"Circulation"},{"key":"5708_CR16","doi-asserted-by":"publisher","first-page":"43","DOI":"10.48305\/arya.2022.26680.2821","volume":"19","author":"M Sadeghi","year":"2023","unstructured":"Sadeghi M, Kermani-Alghoraishi M, Khosravi A, Amerizadeh A, Sadeghi M. Cardiovascular and Bleeding Events of Ticagrelor Monotherapy after Short-term Dual Antiplatelet Therapy (DAPT) in Diabetics and Non-Diabetics Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. ARYA Atheroscler. 2023;19:43\u201353. https:\/\/doi.org\/10.48305\/arya.2022.26680.2821.","journal-title":"ARYA Atheroscler"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-026-05708-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-026-05708-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-026-05708-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:59:20Z","timestamp":1781643560000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12872-026-05708-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5708"],"URL":"https:\/\/doi.org\/10.1186\/s12872-026-05708-w","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"26 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Scientific and Ethical Committee of the Faculty of Medicine, Ain Shams University (Approval code: MD 307 \/2022, Approval date: December 2022). All patients were informed about the study and provided consents.The authors declare that all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"300"}}