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Objective <p>To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization.</p> Methods <p>We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment.</p> Results <p>Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; <i>p</i> = 0.012; I² = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; <i>p</i> = 0.023; I² = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; <i>p</i> = 0.138; I² = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; <i>p</i> = 0.913; I²=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; <i>p</i> = 0.976; I² = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; <i>p</i> = 0.452; I² = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; <i>p</i> = 0.481; I² = 0%).</p> Conclusion <p>Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together.</p> Trial registratrion <p>CRD420261286239</p>

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‘Aspirin versus ticagrelor for the management after coronary revascularization - a systematic review and meta‑analysis of randomised trials’

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • Dhiraj Raj Regmi,
  • Sabita Regmi,
  • Sachin Upreti,
  • Naveen Gautam

摘要

Objective

To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization.

Methods

We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment.

Results

Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; p = 0.012; I² = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; p = 0.023; I² = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; p = 0.138; I² = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; p = 0.913; I²=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; p = 0.976; I² = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; p = 0.452; I² = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; p = 0.481; I² = 0%).

Conclusion

Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together.

Trial registratrion

CRD420261286239