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Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial

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dc.contributor.author신동호-
dc.contributor.author권혁문-
dc.contributor.author고영국-
dc.contributor.author김중선-
dc.contributor.author김병극-
dc.contributor.author장양수-
dc.contributor.author홍명기-
dc.contributor.author홍범기-
dc.contributor.author최동훈-
dc.contributor.author조덕규-
dc.contributor.author안철민-
dc.contributor.author남정모-
dc.contributor.author홍성진-
dc.date.accessioned2020-09-29T01:06:59Z-
dc.date.available2020-09-29T01:06:59Z-
dc.date.issued2020-06-
dc.identifier.issn0098-7484-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/179404-
dc.description.abstractImportance: Discontinuing aspirin after short-term dual antiplatelet therapy (DAPT) was evaluated as a bleeding reduction strategy. However, the strategy of ticagrelor monotherapy has not been exclusively evaluated in patients with acute coronary syndromes (ACS). Objective: To determine whether switching to ticagrelor monotherapy after 3 months of DAPT reduces net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with ACS treated with drug-eluting stents. Design, setting, and participants: A randomized multicenter trial was conducted in 3056 patients with ACS treated with drug-eluting stents between August 2015 and October 2018 at 38 centers in South Korea. Follow-up was completed in October 2019. Interventions: Patients were randomized to receive ticagrelor monotherapy (90 mg twice daily) after 3-month DAPT (n = 1527) or ticagrelor-based 12-month DAPT (n = 1529). Main outcomes and measures: The primary outcome was a 1-year net adverse clinical event, defined as a composite of major bleeding and adverse cardiac and cerebrovascular events (death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization). Prespecified secondary outcomes included major bleeding and major adverse cardiac and cerebrovascular events. Results: Among 3056 patients who were randomized (mean age, 61 years; 628 women [20%]; 36% ST-elevation myocardial infarction), 2978 patients (97.4%) completed the trial. The primary outcome occurred in 59 patients (3.9%) receiving ticagrelor monotherapy after 3-month DAPT and in 89 patients (5.9%) receiving ticagrelor-based 12-month DAPT (absolute difference, -1.98% [95% CI, -3.50% to -0.45%]; hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.92]; P = .01). Of 10 prespecified secondary outcomes, 8 showed no significant difference. Major bleeding occurred in 1.7% of patients with ticagrelor monotherapy after 3-month DAPT and in 3.0% of patients with ticagrelor-based 12-month DAPT (HR, 0.56 [95% CI, 0.34 to 0.91]; P = .02). The incidence of major adverse cardiac and cerebrovascular events was not significantly different between the ticagrelor monotherapy after 3-month DAPT group (2.3%) vs the ticagrelor-based 12-month DAPT group (3.4%) (HR, 0.69 [95% CI, 0.45 to 1.06]; P = .09). Conclusions and relevance: Among patients with acute coronary syndromes treated with drug-eluting stents, ticagrelor monotherapy after 3 months of dual antiplatelet therapy, compared with ticagrelor-based 12-month dual antiplatelet therapy, resulted in a modest but statistically significant reduction in a composite outcome of major bleeding and cardiovascular events at 1 year. The study population and lower than expected event rates should be considered in interpreting the trial. Trial registration: ClinicalTrials.gov Identifier: NCT02494895.-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherAmerican Medical Association-
dc.relation.isPartOfJAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.titleEffect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학교실)-
dc.contributor.googleauthorByeong-Keuk Kim-
dc.contributor.googleauthorSung-Jin Hong-
dc.contributor.googleauthorYun-Hyeong Cho-
dc.contributor.googleauthorKyeong Ho Yun-
dc.contributor.googleauthorYong Hoon Kim-
dc.contributor.googleauthorYongsung Suh-
dc.contributor.googleauthorJae Young Cho-
dc.contributor.googleauthorAe-Young Her-
dc.contributor.googleauthorSungsoo Cho-
dc.contributor.googleauthorDong Woon Jeon-
dc.contributor.googleauthorSang-Yong Yoo-
dc.contributor.googleauthorDeok-Kyu Cho-
dc.contributor.googleauthorBum-Kee Hong-
dc.contributor.googleauthorHyuckmoon Kwon-
dc.contributor.googleauthorChul-Min Ahn-
dc.contributor.googleauthorDong-Ho Shin-
dc.contributor.googleauthorChung-Mo Nam-
dc.contributor.googleauthorJung-Sun Kim-
dc.contributor.googleauthorYoung-Guk Ko-
dc.contributor.googleauthorDonghoon Choi-
dc.contributor.googleauthorMyeong-Ki Hong-
dc.contributor.googleauthorYangsoo Jang-
dc.contributor.googleauthorTICO Investigators-
dc.identifier.doi10.1001/jama.2020.7580-
dc.contributor.localIdA02097-
dc.contributor.localIdA00260-
dc.contributor.localIdA00127-
dc.contributor.localIdA00961-
dc.contributor.localIdA00493-
dc.contributor.localIdA03448-
dc.contributor.localIdA04391-
dc.contributor.localIdA04394-
dc.contributor.localIdA04053-
dc.contributor.localIdA03813-
dc.contributor.localIdA02269-
dc.contributor.localIdA01264-
dc.contributor.localIdA04403-
dc.relation.journalcodeJ01196-
dc.identifier.eissn1538-3598-
dc.identifier.pmid32543684-
dc.identifier.urlhttps://jamanetwork.com/journals/jama/fullarticle/2767161-
dc.contributor.alternativeNameShin, Dong Ho-
dc.contributor.affiliatedAuthor신동호-
dc.contributor.affiliatedAuthor권혁문-
dc.contributor.affiliatedAuthor고영국-
dc.contributor.affiliatedAuthor김중선-
dc.contributor.affiliatedAuthor김병극-
dc.contributor.affiliatedAuthor장양수-
dc.contributor.affiliatedAuthor홍명기-
dc.contributor.affiliatedAuthor홍범기-
dc.contributor.affiliatedAuthor최동훈-
dc.contributor.affiliatedAuthor조덕규-
dc.contributor.affiliatedAuthor안철민-
dc.contributor.affiliatedAuthor남정모-
dc.contributor.affiliatedAuthor홍성진-
dc.citation.volume323-
dc.citation.number23-
dc.citation.startPage2407-
dc.citation.endPage2416-
dc.identifier.bibliographicCitationJAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol.323(23) : 2407-2416, 2020-06-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers

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