Men and women benefit equally from early aspirin withdrawal following PCI

A recent sub-group analysis of the TWILIGHT trial showed that while post-percutaneous coronary intervention (PCI) bleeding occurs more frequently in women, these differences are mostly attributable to baseline differences. Ischaemic events were similar between the sexes [1].

The TWILIGHT study (NCT02270242) was a blinded dual-arm study comparing the use of ticagrelor plus aspirin with the use of ticagrelor plus a placebo (ticagrelor monotherapy) for 1 year in high-risk patients who had undergone PCI and had already completed 3 months of dual antiplatelet therapy. TWILIGHT demonstrated that the risk of bleeding could be decreased without a corresponding increased risk of an ischaemic event.

Dr Birgit Vogel (Icahn School of Medicine, USA) presented a pre-planned sub-group analysis that explored any heterogeneity of outcomes between the sexes. The investigators stratified outcomes by sex according to 2 endpoints among the 7,119 randomised participants. The 2 endpoints of this analysis were a primary bleeding event (defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding) at 1 year, and a primary ischaemic event (defined as a composite of death, myocardial infarction, or stroke) at 1 year.

Women more frequently experienced the primary bleeding endpoint than men (HR 1.32; 95% CI 1.06-1.64; P=0.01). However, after multivariate adjustment, this increased risk was deemed not significant (adjusted HR 1.20; 95%CI 0.95-1.52; P=0.12). The ischaemic endpoints were similar between the sexes.

Researchers concluded that the clinical benefits of withdrawal of aspirin therapy following 3 months of dual antiplatelet therapy were generally the same in men and women, and that further studies should be done to explore these benefits in women.

1. 
   
   1. Vogel B. Sex-Specific Outcomes in High-Risk Patients Receiving Ticagrelor with or without Aspirin After Percutaneous Coronary Intervention: Results from the TWILIGHT Study. ACC 2021 Scientific Session, 15-17 May.

Posted on 17 May, 20216 July, 2021