Early Use of Low-dose Ticagrelor-based Dual Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Complex Lesions

Ticagrelor-based dual antiplatelet therapy (TDAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the impact of the early use of low-dose TDAPT (l-TDAPT; 120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients on standard-dose TDAPT (s-TDAPT; 180 mg) after PCI for complex lesions. A major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization. A net clinical event (NCE) was defined as a composite of bleeding events and MACEs. Among the 772 patients on s-TDAPT, 115 (14.8%) switched to l-TDAPT within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariate Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding events, and NCE were not different between the l-TDAPT and s-TDAPT groups during the entire follow-up period and beyond 6 months after PCI. Multivariate time-varying CPH also showed similar results. De-escalation with low-dose ticagrelor within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.