Dual antiplatelet therapy (DAPT), the combination of aspirin and a P2Y12 inhibitor, represents the standard of care for the prevention of ischemic events in patients undergoing percutaneous coronary interventions (PCIs).1,2 However, these effects are countered by bleeding complications, which are associated with an increased morbidity and mortality.3,4 For these reasons, new antiplatelet regimens – including P2Y12 inhibitor monotherapy after a short period of DAPT - have been examined to decrease the risk of bleeding while maintaining protection from ischemic events in patients undergoing PCI.5., 6., 7. The TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial showed that in patients undergoing PCI who have high-risk features for recurrent ischemia or bleeding complications, ticagrelor monotherapy after 3-months of DAPT reduced bleeding without increasing ischemic harm compared to DAPT continuation.8

PAD affects about 6.5 million (6%) individuals in the United States and >230 million worldwide; its prevalence nearly doubled in the last 30 years.9., 10., 11. PAD is frequently associated with multiple other important co-morbidities, including advanced coronary artery disease (CAD).12 Up to 10% of patients undergoing PCI have concomitant PAD and are at increased risk of mortality as well as of recurrent ischemic or bleeding complications.13., 14., 15. Prior studies showed that patients with PAD without high bleeding risk (HBR) characteristics might benefit from prolonged DAPT or the addition of low-dose rivaroxaban to aspirin for chronic maintenance after PCI.16., 17., 18., 19. However, the effects of ticagrelor monotherapy after PCI in this complex population are largely unknown.

The aim of the current analysis was to compare the effect of ticagrelor monotherapy versus ticagrelor plus aspirin among patients with PAD undergoing PCI using data from the TWILIGHT trial.