Ticagrelor Monotherapy Shows Cardiovascular Benefit in Patients with Diabetes


Ticagrelor alone, without aspirin, reduced bleeding without increasing the cardiovascular risks.

Cardiovascular Health

Treatment with ticagrelor, an anti-platelet medication, alone demonstrated cardiovascular benefit in patients with diabetes when compared with dual therapy of ticagrelor and aspirin, according to new research presented at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The findings were also published in the Journal of the American College of Cardiology.

The study, known as the TWILIGHT trial, examined whether ticagrelor alone or ticagrelor plus aspirin more effectively reduced bleeding without increasing the risk for heart attacks, stroke, death, or other adverse events caused by arterial blockages in patients who had received at least 1 stent and were at high risk for adverse events.

In the trial, 9006 patients at 187 medical centers in 11 countries were enrolled. Patients had received at least 1 stent and were at high risk for bleeding or another arterial blockage.

For the current study, 2670 patients with diabetes were evaluated. Of these patients, those who received ticagrelor plus a placebo were less likely to have clinically significant bleeding compared with those who received ticagrelor plus aspirin, 4.5% versus 6.7%, respectively.

Additionally, 4.6% of patients treated with ticagrelor plus a placebo died or had a heart attack or stroke, compared with 5.9% of those who received ticagrelor plus aspirin, according to the study findings. The authors noted that, although not statistically significant, the findings suggest that eliminating aspirin does not have any negative effects on patients.

According to the authors, patients in the study were diagnosed with diabetes, but this was not confirmed by laboratory testing, citing one of the study’s limitations. Additionally, patients with the most severe type of heart attack were excluded from the trial.

“These findings were consistent with the overall results of the TWILIGHT trial and were seen across all types of diabetes patients, irrespective of their clinical presentation and the treatment they were receiving for their diabetes,” study author Dominick J. Angiolillo, MD, PhD, professor of medicine at the University of Florida College of Medicine in Jacksonville, Florida, said in a press release.

He noted that the results concluded that eliminating aspirin reduced bleeding without increasing risk of death, heart attack, or strokes. However, further research is needed to identify the best treatment for patients after they have completed 1 year on ticagrelor monotherapy.


1. Ticagrelor Alone, Without Aspirin, Shows Benefit in Patients with Diabetes [news release]. American College of Cardiology’s website. https://www.acc.org/about-acc/press-releases/2020/03/29/21/22/ticagrelor-alone-without-aspirin-shows-benefit-in-patients-with-diabetes. Accessed March 31, 2020.

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