title: Long-Term Use of Ticagrelor in Patients with Coronary Artery Disease.
abstract: This review aims to summarize and discuss safety and effectiveness of the long-term use of ticagrelor in patients with coronary artery disease (CAD).
  
  
  
  Ticagrelor is an orally administered, direct, and reversible inhibitor of the P2Y12-platelet receptor. Long-term use of ticagrelor in patients with previous myocardial infarction (MI) has been investigated in the PEGASUS-TIMI-54 trial. Overall, 21,162 patients with a spontaneous MI 1 to 3 years before randomization were randomly assigned to ticagrelor 90 mg bid, ticagrelor 60 mg bid, or placebo. Compared with placebo, both doses of ticagrelor showed that they were capable of significantly reducing the primary efficacy endpoint, although with a significant increase in TIMI major bleeding. Intracranial hemorrhage or fatal bleeding did not differ across groups. These findings establish clear benefit of DAPT extension with ticagrelor beyond 1 year of treatment, which comes with a tradeoff of clinically meaningful bleeding. Altogether, current evidence suggests that the duration of DAPT remains a patient-by-patient decision based on thrombotic and bleeding risk profiles.
authors.affiliation: Department of Cardiology, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Ariotti
authors.affiliation: Department of Cardiology, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.|Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: Department of Cardiology, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland. marco.valgimigli@insel.ch.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D001792:Blood Platelets / Q000187:drug effects; D003324:Coronary Artery Disease / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013927:Thrombosis / Q000139:chemically induced; D000077486:Ticagrelor; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine
keywords: Antiplatelet therapy; Bleeding events; Coronary artery disease; Ischemic events; P2Y12 inhibitor; Ticagrelor