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Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index.

Publication ,  Journal Article
Kunadian, V; Baber, U; Pivato, CA; Cao, D; Dangas, G; Sartori, S; Zhang, Z; Angiolillo, DJ; Briguori, C; Cohen, DJ; Collier, T; Dudek, D ...
Published in: JACC Cardiovasc Interv
October 10, 2022

BACKGROUND: There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. OBJECTIVES: The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. METHODS: The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. RESULTS: Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI. CONCLUSIONS: Among high-risk patients undergoing percutaneous coronary intervention, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced bleeding events without any increase in ischemic risk across different BMI categories.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

October 10, 2022

Volume

15

Issue

19

Start / End Page

1948 / 1960

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Overweight
  • Obesity
  • Humans
  • Hemorrhage
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology
 

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Kunadian, V., Baber, U., Pivato, C. A., Cao, D., Dangas, G., Sartori, S., … Mehran, R. (2022). Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index. JACC Cardiovasc Interv, 15(19), 1948–1960. https://doi.org/10.1016/j.jcin.2022.07.039
Kunadian, Vijay, Usman Baber, Carlo A. Pivato, Davide Cao, George Dangas, Samantha Sartori, Zhongjie Zhang, et al. “Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index.JACC Cardiovasc Interv 15, no. 19 (October 10, 2022): 1948–60. https://doi.org/10.1016/j.jcin.2022.07.039.
Kunadian V, Baber U, Pivato CA, Cao D, Dangas G, Sartori S, et al. Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index. JACC Cardiovasc Interv. 2022 Oct 10;15(19):1948–60.
Kunadian, Vijay, et al. “Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index.JACC Cardiovasc Interv, vol. 15, no. 19, Oct. 2022, pp. 1948–60. Pubmed, doi:10.1016/j.jcin.2022.07.039.
Kunadian V, Baber U, Pivato CA, Cao D, Dangas G, Sartori S, Zhang Z, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Dehghani P, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Džavík V, Gurbel P, Hamm CW, Henry T, Kastrati A, Marx SO, Oldroyd K, Steg PG, Pocock S, Mehran R. Bleeding and Ischemic Outcomes With Ticagrelor Monotherapy According to Body Mass Index. JACC Cardiovasc Interv. 2022 Oct 10;15(19):1948–1960.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

October 10, 2022

Volume

15

Issue

19

Start / End Page

1948 / 1960

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticagrelor
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Overweight
  • Obesity
  • Humans
  • Hemorrhage
  • Drug Therapy, Combination
  • Cardiovascular System & Hematology