Cited by 1,999Antiplatelet Therapy and Cardiovascular DiseasesAcute Myocardial Infarction ResearchCoronary Interventions and Diagnostics

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Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction

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Bonaca, Marc P., Bhatt, Deepak L., Cohen, Marc, Steg, Philippe Gabriel, Storey, Robert F., Jensen, Eva C., Magnani, Giulia, Bansilal, Sameer, Fish, M. Polly, Im, Kyungah, Bengtsson, Olof, Ophuis, Ton Oude, Budaj, Andrzej, Theroux, Pierre, Ruda, Mikhail, Hamm, Christian, Goto, Shinya, Spinar, Jindrich, Nicolau, José Carlos, Kiss, Robert G., Murphy, Sabina A., Wiviott, Stephen D., Held, Peter, Braunwald, Eugene, Sabatine, Marc S.·2015·New England Journal of Medicine

DOI 10.1056/nejmoa1500857

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Abstract

BACKGROUND: The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context. METHODS: We randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. RESULTS: The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P=0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P=0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. CONCLUSIONS: In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.).

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ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary
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Self-citation
Ticagrelor versus clopidogrel in patients with acute coronary syndromes
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Prasugrel versus clopidogrel in patients with acute coronary syndromes
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Self-citation
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Percutaneous Coronary Intervention
Rinfret, S., Baron, S. J., & Cohen, D. J. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.04.041 · Cited by 11
Improved long-term survival after acute myocardial infarction: the success of comprehensive care from the acute stage to the long term
Danchin, N. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac714 · Cited by 11
Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy
Bagai, A., Wang, T. Y., Goodman, S. G., Fisher, H. N., Welsh, R. C., Déry, J., Zhang, X., Zhu, Y. E., Cheema, A. N., Dehghani, P., et al. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.11.240 · Cited by 10
Antithrombotic Therapy in Myocardial Infarction: Historic Perils and Current Challenges—A 70-Year Journey
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How to fill the GAPS-I in secondary prevention: application of a strategy based on GLP1 analogues, antithrombotic agents, PCSK9 inhibitors, SGLT2 inhibitors and immunomodulators
Sabouret, P. F., Angoulvant, D., Pathak, A., Fysekidis, M., Laterra, G., Costa, F., Angelini, F., Bocchino, P. P., Montalescot, G., & Biondi‐Zoccai, G. (2021) · Panminerva Medica · doi:10.23736/s0031-0808.21.04284-1 · Cited by 10
Antithrombotic therapy in peripheral arterial disease
Espinola–Klein, C., Weißer, G., Schmitt, V. H., Schwaderlapp, M., & Münzel, T. F. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.927645 · Cited by 10
“The PEGASUS (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin) study showed beneficial effect of long-term use of ticagrelor and aspirin more than 12 months after acute myocardial infarction (30).”
Method
Dual or single antiplatelet therapy after coronary surgery for acute coronary syndrome (TACSI trial): Rationale and design of an investigator-initiated, prospective, multinational, registry-based randomized clinical trial
Malm, C. J., Alfredsson, J., Erlinge, D., Guðbjartsson, T., Gunn, J. M., James, S. K., Møller, C. H., Nielsen, S. J., Sartipy, U., Tønnessen, T., et al. (2023) · American Heart Journal · doi:10.1016/j.ahj.2023.01.011 · Cited by 10
De-escalation strategies in patients with acute coronary syndrome: a step towards precision medicine
Gragnano, F., Capolongo, A., Terracciano, F., Sio, V. D., Maddaluna, P., Fimiani, F., Moscarella, E., Cesaro, A., Montone, R. A., Bianco, R., et al. (2023) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2023.2221851 · Cited by 10
“The risk of ischemic events can be reduced by using intense DAPT regimens instead of clopidogrel-based DAPT [7,8] and by extending DAPT duration instead of switching to aspirin monotherapy [9,10].”
Background
Ticagrelor inverse agonist activity at the P2Y12 receptor is non‐reversible versus its endogenous agonist adenosine 5´‐diphosphate
Khalil, J. S., Dimofte, T., Roberts, T., Keith, M., Amaradasa, K. S., Hindle, M. S., Bancroft, S., Hutchinson, J. L., Naseem, K. M., Johnson, T., et al. (2023) · British Journal of Pharmacology · doi:10.1111/bph.16204 · Cited by 11
“The central aim of this current study was to further elucidate the mode superiority over many antiplatelet agents (Bonaca et al., 2015; Wallentin et al., 2009).”
Background
Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial Infarction With High Ischemic Risk
Lee, M., Byun, S., Lim, S., Choo, E. H., Lee, K. Y., Moon, D., Choi, I. J., Hwang, B., Kim, C. J., Park, M., et al. (2023) · JAMA Cardiology · doi:10.1001/jamacardio.2023.4587 · Cited by 10
Precision Medicine in Acute Coronary Syndromes
Caffè, A., Animati, F. M., Iannaccone, G., Rinaldi, R., & Montone, R. A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13154569 · Cited by 11
“…with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin) trial demonstrated that prolonged ticagrelor-based DAPT decreased MACE in patients with a previous MI with or without preceding coronary stent implantation, at the expense of a higher bleeding risk [75].”
Method
Abbreviated or Standard Antiplatelet Therapy After PCI in Diabetic Patients at High Bleeding Risk
Roffi, M., Landi, A., Heg, D., Frigoli, E., Chalkou, K., Chevalier, B., Ijsselmuiden, A. J. J., Kastberg, R., Komiyama, N., Morice, M., et al. (2024) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2024.08.030 · Cited by 11
Long-term Cardiovascular Risk After Acute Coronary Syndrome, An Ongoing Challenge
Bueno, H., & Martín‐Asenjo, R. (2015) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2015.08.020 · Cited by 10
Dyspnea in patients treated with P2Y12 receptor antagonists: insights from the GReek AntiPlatElet (GRAPE) registry
Alexopoulos, D. K., Xanthopoulou, I., Perperis, A., Goudevenos, J. A., Hamilos, M. I., Sitafidis, G., Kanakakis, J., Vavouranakis, M., Γιαννόπουλος, Γ., Barampoutis, N., et al. (2017) · Platelets · doi:10.1080/09537104.2016.1265919 · Cited by 10
“84% in the 90 mg bid and 60 mg bid of ticagrelor-treated patients, respectively [19].”
Background
Update ESC-Leitlinie 2017 – Akuter Myokardinfarkt (STEMI)
Jung, C., & Elsässer, A. (2018) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-0494-0341 · Cited by 10
“Üblicherweise wird eine duale Thrombozytenaggregationshemmung (DAPT) über 12 Monate empfohlen, jedoch sollte bei der Festlegung die Therapiedauer das individuelle Ischämie- und Blutungsrisiko des Patienten berücksichtigt werden [13].”
Background
One-year clinical outcomes of ticagrelor compared with clopidogrel after percutaneous coronary intervention in patients with acute myocardial infarction: From Korean Health Insurance Review and Assessment Data
Kim, C., Shin, D., Hong, S., Ahn, C., Kim, J., Kim, B., Ko, Y., Choi, D., Hong, M., Park, J., et al. (2019) · Journal of Cardiology · doi:10.1016/j.jjcc.2018.08.005 · Cited by 9
Absorb Bioresorbable Scaffold Versus Xience Metallic Stent for Prevention of Restenosis Following Percutaneous Coronary Intervention in Patients at High Risk of Restenosis: Rationale and Design of the COMPARE ABSORB Trial
Chang, C. C., Onuma, Y., Achenbach, S., Barbato, E., Chevalier, B., Cook, S., Dudek, D., Escaned, J., Gori, T., Kočka, V., et al. (2019) · Cardiovascular revascularization medicine · doi:10.1016/j.carrev.2019.04.013 · Cited by 10
“The PEGASUS-TIMI 54 trial [25] evaluated long-term therapy with ticagrelor in addition to aspirin, in patients with a history of spontaneousMI occurring 1 to 3 years prior to randomization and concluded that ticagrelor significantly reduced the risk of MACE compared with placebo.”
Method
Role of and Recent Evidence for Antiplatelet Therapy in Prevention of Cardiovascular Disease in Diabetes
Sharma, A., Deyell, J., Sharma, S. N., & Barseghian, A. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1168-y · Cited by 10
Antithrombotic strategies for patients with coronary and lower extremity peripheral artery diseases: a narrative review
Luca, L. D., Bonaca, M. P., & Magnani, G. (2020) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2020.1833719 · Cited by 15
Self-citation
ESC-Leitlinie 2020: akutes Koronarsyndrom ohne persistierende ST-Strecken-Hebungen
Thiele, H., & Jobs, A. (2020) · Herz · doi:10.1007/s00059-020-05002-1 · Cited by 12
Challenges of long-term dual antiplatelet therapy use following acute coronary syndromes
Sidhu, M. S., Lyubarova, R., Bangalore, S., & Bonaca, M. P. (2021) · American Heart Journal · doi:10.1016/j.ahj.2021.12.005 · Cited by 10
Self-citation
Ticagrelor vs. Clopidogrel in Acute Coronary Syndrome Patients With Chronic Kidney Disease After New-Generation Drug-Eluting Stent Implantation
Roh, J. W., Lee, S., Kim, B., Hong, S., Kim, H.-Y., Ahn, C., Cho, D., Kim, J., Ko, Y., Choi, D., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.707722 · Cited by 10
Impact of Ticagrelor vs. Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention After Risk Stratification With the CHA2DS2-VASc Score
Na, K., Qiu, M., Ma, S., Li, Y., Li, J., Liu, R., Zhang, J., & Han, Y. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.808571 · Cited by 10
Development of a long-acting tablet with ticagrelor high-loaded nanostructured lipid carriers
Jung, M., Jin, M., Jeon, W.-J., Lee, H., Kim, H., Won, J.-H., Yoo, H., Bai, H.-W., Han, S.-C., Suh, H., et al. (2022) · Drug Delivery and Translational Research · doi:10.1007/s13346-022-01205-7 · Cited by 10
Switching from Dual Antiplatelet Therapy with Aspirin Plus a P2Y12 Inhibitor to Dual Pathway Inhibition with Aspirin Plus Vascular-Dose Rivaroxaban: The Switching Anti-Platelet and Anti-Coagulant Therapy (SWAP-AC) Study
Ortega‐Paz, L., Franchi, F., Rollini, F., Galli, M., Been, L. F., Ghanem, G., Shalhoub, A., Ossi, T., Rivas, A., Zhou, X., et al. (2023) · Thrombosis and Haemostasis · doi:10.1055/a-2098-6639 · Cited by 10
Targeted therapy with a localised abluminal groove, low-dose sirolimus-eluting, biodegradable-polymer coronary stent – five-year results of the TARGET All Comers randomised clinical trial
Lansky, A. J., Xu, B., Baumbach, A., Kelbæk, H., van Royen, N., Zheng, M., Knaapen, P., Slagboom, T., Johnson, T., Vlachojannis, G. J., et al. (2023) · EuroIntervention · doi:10.4244/eij-d-23-00409 · Cited by 10
Thrombosis in ST-elevation myocardial infarction: Insights from thrombi retrieved by aspiration thrombectomy
Ribeiro, D. R. P., Cambruzzi, E., Schmidt, M. M., & de Quadros, A. S. (2016) · World Journal of Cardiology · doi:10.4330/wjc.v8.i6.362 · Cited by 10
Long-Term P2Y12-Receptor Antagonists in Post-Myocardial Infarction Patients
Alexopoulos, D. K., Xanthopoulou, I., Μούλιας, Α., & Lekakis, J. P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.05.088 · Cited by 10
Role of New Antiplatelet Drugs on Cardiovascular Disease: Update on Cangrelor
Marcano, A. L., & Ferreiro, J. L. (2016) · Current Atherosclerosis Reports · doi:10.1007/s11883-016-0617-y · Cited by 9
Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome
Gimbel, M. E., & ten Berg, J. M. (2017) · Netherlands Heart Journal · doi:10.1007/s12471-017-1002-3 · Cited by 10
“fect of prolonged DAPT with ticagrelor in patients with prior MI [45].”
Background
Low-Dose Ticagrelor Versus Clopidogrel in Patients With Prior Myocardial Infarction
Alexopoulos, D. K., Despotopoulos, S., Xanthopoulou, I., & Davlouros, P. A. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.08.031 · Cited by 10
“In the PEGASUS-TIMI 54 (Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin– Thrombolysis In Myocardial Infarction 54) trial, both ticagrelor doses reduced the ischemic events over placebo; the 60-mg dose demonstrated a more attractive benefit-to-risk profile (3).”
Method
Study protocol for a randomised controlled trial: harmonising optimal strategy for treatment of coronary artery stenosis — coronary intervention with next-generation drug-eluting stent platforms and abbreviated dual antiplatelet therapy (HOST-IDEA) trial
Kim, C., Han, J., Yang, H., Park, K. W., Lee, H., Kang, H., Koo, B., Lee, N., Cha, T., Yang, T., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016617 · Cited by 10
Antiplatelet Therapy in Coronary Artery Disease: A Daunting Dilemma
Chaturvedula, S. T., Diver, D. J., & Vashist, A. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm7040074 · Cited by 11
Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry
D’Ascenzo, F., Celentani, D., Brustio, A., Grosso, A., Raposeiras‐Roubín, S., Abu‐Assi, E., Henriques, J. P. S., Saucedo, J., González‐Juanatey, J. R., Wilton, S. B., et al. (2018) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-018-0273-4 · Cited by 10
Prevalence, long-term prognosis and medical alternatives for patients admitted for acute coronary syndromes and prasugrel contraindication
Cordero, A., García‐Acuña, J. M., Rodríguez‐Mañero, M., Agra-Bermejo, R., Cid, B., Álvarez, B. Á., Bertomeu‐González, V., Fácila, L., Bertoméu, V., & González‐Juanatey, J. R. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.06.057 · Cited by 10
Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention
Ulvenstam, A., Henriksson, R., Söderström, L., & Mooe, T. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318784082 · Cited by 10
Antiplatelet agents in uncertain clinical scenarios—a bleeding nightmare
Esmonde, S., Sharma, D., & Peace, A. J. (2018) · Cardiovascular Diagnosis and Therapy · doi:10.21037/cdt.2018.06.09 · Cited by 10
“Studies have evaluated bleeding events at 30 days, 3 months, 6 months, 1 year, and indeed 3 years depending on the study (4-6,30,55,56).”
Background
Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction
Schiele, F., Lemesle, G., Angoulvant, D., Krempf, M., Kownator, S., Cheggour, S., Belle, L., Ferrières, J., Bauters, C., Bergerot, C., et al. (2019) · European Heart Journal Acute Cardiovascular Care · doi:10.1177/2048872619844444 · Cited by 11
Assessment of patients with coronary artery disease who may benefit from the use of rivaroxaban in the real world: implementation of the COMPASS trial in the TERCET registry population
Desperak, P., Hudzik, B., & Gąsior, M. (2019) · Polskie Archiwum Medycyny Wewnętrznej · doi:10.20452/pamw.14907 · Cited by 10
Dual antiplatelet therapy beyond 12 months versus for 12 months after drug-eluting stents for acute myocardial infarction
Sim, D. S., Jeong, M. H., Kim, H.-S., Gwon, H., Seung, K. B., Rha, S., Chae, S. C., Kim, C. J., Cha, K. S., Park, J., et al. (2019) · Journal of Cardiology · doi:10.1016/j.jjcc.2019.06.006 · Cited by 10
Novel Oral Anticoagulants Following Percutaneous Coronary Intervention
Abadie, B. Q., Cannon, C. P., & Cavender, M. A. (2020) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.119.008465 · Cited by 11
Optimal duration and combination of antiplatelet therapies following percutaneous coronary intervention: a meta-analysis
Gelbenegger, G., Erari-Canyurt, U., Grafeneder, J., Jilma, B., Lesiak, M., Komosa, A., Caterina, R. D., Postula, M. A., & Siller-Matula, J. M. (2021) · Vascular Pharmacology · doi:10.1016/j.vph.2021.106858 · Cited by 10
Multi-Omics Signatures Link to Ticagrelor Effects on Vascular Function in Patients With Acute Coronary Syndrome
Tam, C. C., Chan, Y., Wong, Y., Li, Z., Zhu, X., Su, K.-J., Ganguly, A., Hwa, K., Ling, X. B., & Tse, H. (2022) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.121.317513 · Cited by 10
Regulation of mitochondrial function by hydroquinone derivatives as prevention of platelet activation
Eduardo Fuentes, Q., Arauna, D., & Araya‐Maturana, R. (2023) · Thrombosis Research · doi:10.1016/j.thromres.2023.08.013 · Cited by 10
The pharmacodynamics of low and standard doses of ticagrelor in patients with end stage renal disease on hemodialysis
Kim, J. S., Woo, J. S., Kim, J., Kim, W.-S., Lee, T. W., Kim, K. S., Ihm, C. G., Kim, W., & Jeong, K. H. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.03.026 · Cited by 10
Highlights from the 2019 International Aspirin Foundation Scientific Conference, Rome, 28 June 2019: benefits and risks of antithrombotic therapy for cardiovascular disease prevention
Cattaneo, M., Badimón, L., Agnelli, G., Chan, A. T., Lanas, Á., Rocca, B., Rothwell, P. M., Patrignani, P., Langley, R. E., Vilahur, G., et al. (2020) · ecancermedicalscience · doi:10.3332/ecancer.2019.998 · Cited by 10
Ticagrelor for patients with acute coronary syndromes: PLATOnic affair or lasting SWEDEHEART?
Pareek, M., & Bhatt, D. L. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw356 · Cited by 10
“Furthermore, the number of patients receiving long-term ticagrelor is likely to have been small, as subject inclusion took place before randomized trial analyses assessing extended ticagrelor were available.(11) Unintentional non-adherence to contemporary guidelines can occur simply as a result of lack of knowledge or…”
BackgroundSelf-citation
Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes
Bates, E. (2020) · JAMA · doi:10.1001/jama.2020.16238 · Cited by 10
Dual‐Antiplatelet Therapy After Percutaneous Coronary Intervention: How Short Is Too Short?
Mourikis, P., & Polzin, A. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.028775 · Cited by 13
2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD
Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehz486 · Cited by 4,763
Antiplatelet therapy and incident cognitive impairment or dementia—a systematic review and meta-analysis of randomised clinical trials
Kitt, K., Murphy, R., Clarke, A., Reddin, C., Ferguson, J. P., Bosch, J., Whiteley, W. N., Canavan, M. D., Judge, C. S., & O'Donnell, M. J. (2023) · Age and Ageing · doi:10.1093/ageing/afad197 · Cited by 12
“Seven of the included trials investigated single antiplatelet therapy [10, 11, 14, 16, 17, 19, 20], and the other four investigated dual antiplatelet therapy [12, 13, 15, 18] (Supplementary Table S1).”
Background
The Impact of Sex on Antiplatelet and Anticoagulant Thromboprophylaxis in Patients With Peripheral Artery Disease Post-revascularization
Suarez, S. P., Agrawal, A., Patel, S. S., Grobman, B., Ghandour, S., Morená, L., Rodríguez, A., Machlus, K. R., Roy, T. L., Eagleton, M. J., et al. (2024) · Annals of Surgery · doi:10.1097/sla.0000000000006375 · Cited by 9
Guided Antiplatelet Therapy for Stent-Treated Intracranial Aneurysms: A Cluster-Randomized Trial
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Oral P2Y12 Inhibitors: Victims or Perpetrators? A Focused Review on Pharmacokinetic, Clinically Relevant Drug Interactions
Bigagli, E., Angelini, J., Mugelli, A., & Rocca, B. (2025) · European Cardiology Review · doi:10.15420/ecr.2025.12 · Cited by 9
“112 Thus, measuring uric acid is recommended after starting ticagrelor.”
Impact of intracoronary supersaturated oxygen therapy on microvascular obstruction and infarct size in patients with acute anterior myocardial infarction
König, T., Berliner, D., Diekmann, J., Akin, M., Pfeffer, T. J., Martinez, C. S., Garcheva, V., Bengel, F. M., Bauersachs, J. K., & Schäfer, A. (2025) · EuroIntervention · doi:10.4244/eij-d-25-00034 · Cited by 10
Helicobacter pylori Screening After Acute Myocardial Infarction
Hofmann, R., James, S. K., Sundqvist, M. O., Wärme, J., Angerås, O., Alfredsson, J., Erlinge, D., Arefalk, G., Arstad, G., Blomberg, S., et al. (2025) · JAMA · doi:10.1001/jama.2025.15047 · Cited by 9
Prevalence and Prognosis of High-risk Myocardial Infarction Patient Candidates to Extended Antiplatelet Therapy
Marrugat, J., Elosúa, R., Grau, M., Sayols-Baixeras, S., & Degano, I. R. (2016) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2015.12.022 · Cited by 9
“Recently, the PEGASUS-TIMI 54 trial showed that aspirin + ticagrelor beyond 1 year reduced the primary combined end point of cardiovascular death, AMI, or stroke in AMI patients but increased the risk of major bleeding.(7) Patients included in the PEGASUS trial were stable AMI patients aged 50 years and older, with at…”
BackgroundMethodResultInfluential
Safety and Incidence of Cardiovascular Events in Chinese Patients with Acute Coronary Syndrome Treated with Ticagrelor: the 12-Month, Phase IV, Multicenter, Single-Arm DAYU Study
on behalf of the DAYU study investigators, Gao, R., Wu, Y., Liu, H., Su, G., Yuan, Z., Zhang, A., Wang, Y., Wang, Z., Wang, Y., et al. (2018) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-018-6772-3 · Cited by 9
“PLATO and PEGASUS-TIMI 54 were conducted worldwide, and recruited some Asian patients [14, 15].”
BackgroundResult
Impacto pronóstico diferencial del infarto de miocardio comparado con la gravedad de la hemorragia sobre la mortalidad en pacientes contemporáneos con síndrome coronario agudo
Caneiro‐Queija, B., Abu‐Assi, E., Raposeiras‐Roubín, S., Manzano‐Fernández, S., Flores‐Blanco, P. J., López‐Cuenca, Á., Paz, R. C., Gómez-Molina, M., Rodríguez-Rodríguez, J. M., Calvo, F., et al. (2018) · Revista Española de Cardiología · doi:10.1016/j.recesp.2018.02.005 · Cited by 9
“IMC 27,9 [25,4-31,1] 28,1 [25,4-31,3] 27,9 [25,4-31,1] 0,57 28,1 [25,5-31,0] 27,9 [25,3-31,1] 0,94”
COMPASS for Vascular Surgeons
Hussain, M. A., Wheatcroft, M., Nault, P., Lindsay, T. F., Bhatt, D. L., Anand, S. S., Verma, S., & Al-Omran, M. A. (2018) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000597 · Cited by 9
Self-citation
Kommentar zu den 2020er Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms bei Patienten ohne persistierende ST-Strecken-Hebung
Thiele, H., Bauersachs, J. K., Mehilli, J., Möllmann, H., Landmesser, U., & Jobs, A. (2021) · Der Kardiologe · doi:10.1007/s12181-020-00442-9 · Cited by 9
Therapeutic Options for Left Main, Left Main Equivalent, and Three-Vessel Disease
Glazier, J. J., Parra, B. M. R., & Kaki, A. (2021) · International Journal of Angiology · doi:10.1055/s-0041-1723977 · Cited by 9
Long-term dual antiplatelet-induced intestinal injury resulting in translocation of intestinal bacteria into blood circulation increased the incidence of adverse events after PCI in patients with coronary artery disease
Zheng, Y., Wu, T., Guo, Q., Chen, Y., Ma, X., Ma, Y., Zhang, J., & Xie, X. (2021) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2021.04.012 · Cited by 9
Aging and Antithrombotic Treatment
Valeriani, E., Bartimoccia, S., Pignatelli, P., & Pastori, D. (2023) · Antioxidants and Redox Signaling · doi:10.1089/ars.2023.0373 · Cited by 11
Platelet RNA Biomarker of Ticagrelor-Responsive Genes Is Associated With Platelet Function and Cardiovascular Events
Myers, R. A., Ortel, T. L., Waldrop, A., Cornwell, M., Newman, J. D., Levy, N., Barrett, T. J., Ruggles, K. V., Sowa, M. A., Davé, S. S., et al. (2023) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.123.319759 · Cited by 9
Clopidogrel, prasugrel, ticagrelor or vorapaxar in patients with renal impairment: do we have a winner?
Serebruany, V. L., Tomek, A., Pokov, A. N., & Kim, M. H. (2015) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2015.1101343 · Cited by 9
“The methods section noted that PLATO Investigators adjusted both CrCl and GFR for body surface area,[25] something not usually done for Cockcroft–Gault Table 4.”
BackgroundMethodResultInfluential
Dual Antiplatelet Therapy Continuation Beyond 1 Year After Drug-Eluting Stents
Ferrante, G., Condorelli, G., Pagnotta, P. A., & Reimers, B. (2017) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.116.004139 · Cited by 9
Clopidogrel reloading for patients with acute myocardial infarction already on clopidogrel therapy
Doll, J. A., Li, S., Chiswell, K., Roe, M. T., Kosiborod, M., Scirica, B. M., & Wang, T. Y. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx255 · Cited by 9
Low-dose Rivaroxaban Plus Aspirin for the Prevention of Cardiovascular Events: an Evaluation of COMPASS
Bhagirath, V. C., Eikelboom, J. W., & Anand, S. S. (2018) · Future Cardiology · doi:10.2217/fca-2018-0059 · Cited by 9
Non-ST Elevation Myocardial Infarction: Diagnosis and Management
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“Regardless of which P2Y12 receptor inhibitor is chosen, a loading dose should be given as soon as possible in most patients and then a maintenance dose continued for a minimum of 12 months [118].”
Background
Extended dual antiplatelet therapy for Asian patients with acute coronary syndrome: expert recommendations
Chen, W. W. C., Law, K., Li, S.-K., Chan, W. C. K., Cheong, A., Fong, P., Hung, Y., Lai, S. W. K., Leung, G. T.-C., Wong, E., et al. (2019) · Internal Medicine Journal · doi:10.1111/imj.14153 · Cited by 9
Statement on Antiplatelet Agents and Anticoagulants in Cardiology - 2019
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Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial
Furtado, R. H. M., Venkateswaran, R. V., Nicolau, J. C., Gurmu, Y., Bhatt, D. L., Storey, R. F., Steg, P. G., Magnani, G., Goto, S., Dellborg, M., et al. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.015785 · Cited by 9
Self-citation
Long‐term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2‐year observations from the EPICOR Asia study
Zheng, B., Huo, Y., Lee, S. W. L., Sawhney, J. P. S., Kim, H.-S., Krittayaphong, R., Pocock, S., Nhân, V. T., Garcia, A. A., Chin, C. T., et al. (2020) · Clinical Cardiology · doi:10.1002/clc.23400 · Cited by 9
Rapid fluorometric determination of ticagrelor in tablets and rat plasma: Application to pharmacokinetics study
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Colivicchi, F., Fusco, S. A. D., Gulizia, M. M., Luca, L. D., Geraci, G., Nardi, F., Rossini, R., Gonzini, L., Scicchitano, P., Caldarola, P., et al. (2020) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000001132 · Cited by 9
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Impact of age on the comparison between short-term vs 12-month dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-Year follow-up results of the REDUCE trial
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“In the subsequent PEGASUS trial, 21,162 patients who had an MI 1 to 3 years earlier were assigned to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo [80].”
BackgroundMethod
Platelet Inhibition with Ticagrelor 60 mg Versus 90 mg Twice Daily in Elderly Patients with Acute Coronary Syndrome: Rationale and Design of the PLINY THE ELDER Trial
Piccolo, R., Avvedimento, M., Canonico, M. E., Gargiulo, P., Paolillo, R., Conti, V., Piaz, F. D., Filippelli, A., Morisco, C., Simonetti, F., et al. (2022) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-021-07302-y · Cited by 9
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BackgroundMethodInfluential
Prevention of cardiovascular events with antiplatelet treatment: does time of intake matter for aspirin and ADP receptor blockers?
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“stent thrombosis) in the published pivotal landmark trials of this drug (PLATO and PEGASUS-TIMI 54 [33–35]).”
Background
IMPACT OF CANGRELOR OVERDOSING ON BLEEDING COMPLICATIONS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE CHAMPION TRIALS
Angiolillo, D. J., Bhatt, D. L., Steg, P. G., Stone, G. W., White, H. D., Gibson, C. M., Hamm, C. W., Price, M. J., Prats, J., Liu, T., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(15)61905-2 · Cited by 9
Self-citation
Optimal Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention
Majithia, A., & Bhatt, D. L. (2016) · Interventional Cardiology Clinics · doi:10.1016/j.iccl.2016.08.003 · Cited by 9
Self-citation
Dual-antiplatelet Therapy Guidelines and Implications for Perioperative Management
Stawiarski, K. M., Kataria, R., Bravo, C., Villablanca, P., Mohananey, D., Narasimhan, S., & Ramakrishna, H. (2017) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2017.06.033 · Cited by 9
Patients with non-ST segment elevation acute coronary syndromes managed without coronary revascularization: A population needing treatment improvement
Menozzi, A., Servi, S. D., Rossini, R., Ferlini, M., Lina, D., Abrignani, M. G., Capranzano, P., Carrabba, N., Galvani, M., Marchese, A., et al. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.05.066 · Cited by 9
Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft events and thrombosis) randomized controlled trial (NCT02053909)
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Ticagrelor-based antiplatelet regimens in patients treated with coronary artery bypass grafting: a meta-analysis of randomized controlled trials
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Combined with ticagrelor, 50 mg aspirin daily can reduce bleeding events without increasing ischemic risk compared with 75–100 mg aspirin daily in coronary artery disease patients: insights from the TIFU (Ticagrelor in Fuwai Hospital) study
Li, J., Sheng, Z., Tan, Y. T., Liu, C., Zhou, P., Zhou, J., Chen, R., Chen, Y., Song, L., Zhao, H., et al. (2019) · Platelets · doi:10.1080/09537104.2019.1680825 · Cited by 9
Increased platelet inhibition after switching from prasugrel to low-dose ticagrelor in Japanese patients with prior myocardial infarction
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High thrombotic risk increases adverse clinical events up to 5 years after acute myocardial infarction. A nationwide retrospective cohort study
Mureddu, G. F., Greco, C., Rosato, S., D’Errigo, P., Luca, L. D., Badoni, G., Faggiano, P. M., & Seccareccia, F. (2019) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2019.1166 · Cited by 9
“According to diagnostic criteria used in previous epidemiological [11] and clinical studies [12,13] patients were classified as having high thrombotic risk (HTR) on the basis of the presence of at least one of the following characteristics recorded either in the index admission or in the previous 5-year hospitalizatio…”
BackgroundMethodResult
Antiplatelet Therapy and Platelet Activity Testing for Neurointerventional Procedures
Fukuda, K. A., Beaman, C. B., & Szeder, V. (2024) · Stroke Vascular and Interventional Neurology · doi:10.1161/svin.124.001376 · Cited by 8
“12”
Brazilian Society of Angiology and Vascular Surgery guidelines on peripheral artery disease
Erzinger, F. L., Polimanti, A. C., Pinto, D. M., Murta, G. B., Cury, M. V. M., da Silva, R. B., Biagioni, R. B., Belczak, S. Q., Joviliano, E. É., de Araújo, W. J. B., et al. (2024) · Jornal Vascular Brasileiro · doi:10.1590/1677-5449.202300592 · Cited by 10
“However, data from the PEGASUS-TIMI study 94,95 showed that, in patients with PAD and a prior myocardial infarction, which is a selected subset with high ischemic risk, dual antiplatelet therapy (DAT) with aspirin and low dose ticagrelor (60 mg twice a day) was associated with reductions in MACE…”
Antithrombotic therapy following lower extremity endovascular revascularization: The results of a survey of vascular specialists
Jarosinski, M. C., Reitz, K. M., Khamzina, Y., Liang, N. L., Sridharan, N. D., & Tzeng, E. (2024) · JVS-Vascular Insights · doi:10.1016/j.jvsvi.2024.100153 · Cited by 7
“Specifically, one small RCT (N = 80), 6 several subgroup analyses of patients undergoing lower extremity revascularization nested within large cardiovascular RCTs, 12,22 systematic reviews, 8,18 and retrospective studies 11,23 have all reported both limb and cardiovascular advantages of DAPT over aspirin monotherapy.”
Extended Dual Antiplatelet Therapy for Multivessel Coronary Artery Disease
Tian, J., Wang, Z., Wang, Y., Wang, F., Peng, X., Xiao, J., Li, C., Hou, X., Tong, Q., Yu, X., et al. (2026) · New England Journal of Medicine · doi:10.1056/nejmoa2517588 · Cited by 8
Antithrombotic therapy trends in non-valvular atrial fibrillation patients undergoing percutaneous coronary stent implantation: Results from a survey among fellows at the Japanese College of Cardiology
Fukamachi, D., Hirayama, A., Miyauchi, K., Yasuda, S., Ogawa, H., Ito, H., & Daida, H. (2018) · Journal of Cardiology · doi:10.1016/j.jjcc.2018.01.017 · Cited by 8
Rivaroxaban With or Without Aspirin for the Secondary Prevention of Cardiovascular Disease: Clinical Implications of the COMPASS Trial
Nicholls, S. J., & Nelson, A. J. (2019) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-018-00322-4 · Cited by 8
Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention of Recurrent Cardiovascular Events in a Real-World Cohort of Post-Acute Myocardial Infarction Patients
Huang, D., Cheng, Y.-Y., Wong, Y.-T. A., Yung, S.-Y. A., Tam, C. C., Chan, K.-W. K., Lam, C.-C., Yiu, K., Hai, J. J., Lau, C., et al. (2019) · Circulation Journal · doi:10.1253/circj.cj-18-0308 · Cited by 8
Safety and feasibility of low‐dose ticagrelor in patients with ST ‐segment elevation myocardial infarction
Wang, Y., Jiang, Y., Zhi, W., Fu, Y., Wang, Q., Zhou, J., Zheng, S., & Hao, G. (2020) · Clinical Cardiology · doi:10.1002/clc.23517 · Cited by 8
A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes
Alkhalil, M., Kuzemczak, M., Bell, A., Stern, S., Welsford, M., Cantor, W. J., & Goodman, S. G. (2022) · Canadian Medical Association Journal · doi:10.1503/cmaj.202863 · Cited by 10

Authors: Bonaca, M. P., Bhatt, D. L., Cohen, M., Steg, P. G., Storey, R. F., Jensen, E. C., Magnani, G., Bansilal, S., Fish, M. P., Im, K., Bengtsson, O., Ophuis, T. O., Budaj, A., Theroux, P., Ruda, M., Hamm, C., Goto, S., Spinar, J., Nicolau, J. C., Kiss, R. G., Murphy, S. A., Wiviott, S. D., Held, P., Braunwald, E., & Sabatine, M. S.
Affiliations: Newark Beth Israel Medical Center (US)
Brigham and Women's Hospital (US)
University of Sheffield (GB)
AstraZeneca (Sweden) (SE)
Icahn School of Medicine at Mount Sinai (US)
Canisius-Wilhelmina Ziekenhuis (NL)
Grochowski Hospital (PL)
National Medical Research Center of Cardiology (RU)
Justus-Liebig-Universität Gießen (DE)
Tokai University (JP)
Universidade de São Paulo (BR)
ORCID: Bonaca, Marc P.
Bhatt, Deepak L.
Cohen, Marc
Storey, Robert F.
Magnani, Giulia
Im, Kyungah
Bengtsson, Olof
Budaj, Andrzej
Hamm, Christian
Goto, Shinya
Nicolau, José Carlos
Murphy, Sabina A.
Wiviott, Stephen D.
Sabatine, Marc S.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2015-05-07
Volume: 372
Issue: 19
Pages: 1791-1800
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1500857
OpenAlex: W2141358924
Cited by: 1,999
References: 32
Citations by year: 2026: 86 · 2025: 99 · 2024: 102 · 2023: 130 · 2022: 163 · 2021: 189 · 2020: 232 · 2019: 205 · 2018: 220 · 2017: 222 · 2016: 236 · 2015: 108
FWCI: 188.81
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
SZTE Publicatio Repozitórium (University of Szeged) (acceptedVersion, other-oa)
Open Repository and Bibliography (University of Liège) (submittedVersion, other-oa)
HAL (submittedVersion)
University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, other-oa)
Digital Access to Libraries (submittedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Use Siena air (University of Siena) (submittedVersion)
Funders: Japan Society for the Promotion of Science (24390202)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
Keywords: ticagrelor, P2Y12 inhibitors, old myocardial infarction, dual antiplatelet therapy, long-term antiplatelet therapy, cardiovascular mortality, myocardial infarction, stroke, intracranial hemorrhage, aspirin, dose comparison, secondary prevention, bleeding risk, cardiovascular risk reduction
MeSH terms: Ticagrelor, Adenosine, Aged, Aspirin, Cardiovascular Diseases, Double-Blind Method, Drug Administration Schedule, Drug Therapy, Combination, Female, Hemorrhage, Humans, Male, Middle Aged, Myocardial Infarction, Platelet Aggregation Inhibitors, Risk, Intracranial Hemorrhages, Kaplan-Meier Estimate, Secondary Prevention, Purinergic P2Y Receptor Antagonists

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Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction

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