Long term dual antiplatelet therapy after myocardial infarction: retrospective analysis in an outpatient population

By Blausen Medical Communications, Inc. - see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=26986463
Submitted: April 7, 2021
Accepted: July 2, 2021
Published: September 16, 2021
Abstract Views: 1325
PDF: 634
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS.  In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.



PlumX Metrics


Download data is not yet available.


Bonaca MP, Bhatt DL, Cohen M, et al. For the PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791-800. DOI: https://doi.org/10.1056/NEJMoa1500857
Dellborg M, Bonaca MP, Storey RF, et al. Efficacy and safety with ticagrelor in patients with prior myocardial infarction in the approved European Label: insights from PEGASUS-TIMI 54. Eur Heart J Cardiovasc Pharmacother 2019;5:200-6. DOI: https://doi.org/10.1093/ehjcvp/pvz020
Al-Salama ZT, Keating GM, Keam SJ. Ticagrelor: A review in long term secondary prevention of cardiovascular events. Drugs 2017;77:2025–36. DOI: https://doi.org/10.1007/s40265-017-0844-8
Graipe A, Söderström L, Mooe T. Increased use of ticagrelor after myocardial infarction not associated with Intracranial hemorrhage. Results from a Nationwide Swedish Registry. Stroke 2018;49:2877-82. DOI: https://doi.org/10.1161/STROKEAHA.118.022970
Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials. A consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123:2736-47. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.009449
Cesaro A, Taglialatela V, Gragnano F, et al. Low-dose ticagrelor in patients with high ischemic risk and previous myocardial infarction: a multicenter prospective real-world observational study. J Cardiovasc Pharmacol 2020;76:173–80. DOI: https://doi.org/10.1097/FJC.0000000000000856
Bonaca MP, Bhatt DL, Ophuis TO, et al. Long-term tolerability of ticagrelor for the secondary prevention of major adverse cardiovascular events. A secondary analysis of the PEGASUS-TIMI 54 Trial. JAMA Cardiol 2016;1:425-32. DOI: https://doi.org/10.1001/jamacardio.2016.1017
Keenan J. Improving adherence to medication for secondary cardiovascular disease prevention. Eur J Prev Cardiol 2017:24:s29–35. DOI: https://doi.org/10.1177/2047487317708145
Laufs U,Rettig-Ewen V, Bohm M. Strategies to improve drug adherence. Eur Heart J 2011;32:264–8. DOI: https://doi.org/10.1093/eurheartj/ehq297
Parodi G, Storey RF. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor. Eur Heart J Acute Cardiovasc Care 2015;4:555–60. DOI: https://doi.org/10.1177/2048872614554108
Amin AP, Bachuwar A, ReidKJ, et al. Nuisance bleeding with prolonged dual antiplatelet theray after acute myocardial infarction and its impact on health status. J Am Coll Cardiol 2013; 61:2130–8. DOI: https://doi.org/10.1016/j.jacc.2013.02.044
Ratti G, Lizzadro A, Biglietto E, et al. Long term dual antiplatelet therapy for secondary prevention: management model and our experience. Eur Heart J 2020;22:G205-6.
Bonaca MP, Bhatt DL, Steg PG, et al. Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction: insights from PEGASUS-TIMI 54. Eur Heart J 2016;37:1133–42. DOI: https://doi.org/10.1093/eurheartj/ehv531

Supporting Agencies


How to Cite

Ratti, Gennaro, Antonio Maglione, Emilia Biglietto, Cinzia Monda, Ciro Elettrico, Federica Ratti, Cosimo Fulgione, Mario Mallardo, and Paolo Tammaro. 2021. “Long Term Dual Antiplatelet Therapy After Myocardial Infarction: Retrospective Analysis in an Outpatient Population”. Monaldi Archives for Chest Disease 92 (1). https://doi.org/10.4081/monaldi.2021.1881.