Factors related to major bleeding after ticagrelor therapy: Results from the tico trial

Jae Young Cho, Seung Yul Lee, Kyeong Ho Yun, Byeong Keuk Kim, Sung Jin Hong, Jum Suk Ko, Sang Jae Rhee, Seok Kyu Oh, Dong Ho Shin, Chul Min Ahn, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

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7 Citations (Scopus)


BACKGROUND: There is a lack of data on factors that are related to clinically relevant bleeding after ticagrelor treatment. We investigated the clinical and procedural factors related to major bleeding in patients with acute coronary syndrome treated with ticagrelor after coronary stent implantation. METHODS AND RESULTS: From the TICO (Ticagrelor Monotherapy After 3 Months in Patients Treated With New Generation Sirolimus-Eluting Stent for Acute Coronary Syndrome) randomized trial, a total of 2660 patients were included for the present study. Patients with major bleeding, defined by TIMI (Thrombolysis in Myocardial Infarction) major or Bleeding Academic Research Consortium type 3 or 5, were compared with those without major bleeding. On the basis of multivariable and re-ceiver operating characteristic curve analyses, weight ≤65 kg, hemoglobin ≤12 g/dL, and estimated glomerular filtration rate <60 mL/min per 1.73 m2 were associated with an increased risk of major bleeding. In contrast, 3-month aspirin therapy with continued ticagrelor (versus 12-month aspirin and ticagrelor) was associated with a decreased risk of major bleeding. The lower risk of a net adverse clinical event (a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events) in patients treated with 3-month aspirin therapy reported from the TICO trial remained valid in patients with any of these risk factors (hazard ratio, 0.59; 95% CI, 0.39–0.90; Pinteraction =0.74). CONCLUSIONS: Low body weight, anemia, and chronic kidney disease were risk factors for major bleeding after ticagrelor therapy. Early aspirin discontinuation had a net clinical benefit among patients with a bleeding risk.

Original languageEnglish
Article numbere019630
JournalJournal of the American Heart Association
Issue number7
Publication statusPublished - 2021 Apr 6

Bibliographical note

Funding Information:
This study was supported by Wonkwang University in 2020, Iksan, Korea, and the Cardiovascular Research Center, Seoul, Korea.

Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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