Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

TWILIGHT-COMPLEX: Tap ticagrelor monotherapy early after complex PCI

Key clinical point: Ticagrelor without aspirin after complex percutaneous coronary intervention (PCI) is a winning strategy.

Major finding: Patients who underwent complex PCI and then received ticagrelor monotherapy after a brief period of dual-antiplatet therapy (DAPT) had a 4.2% incidence of clinically significant bleeding at 12 months, significantly lower than the 7.7% rate in patients randomized to long-term ticagrelor plus aspirin – and with no increased risk of ischemic events.

Study details: The TWILIGHT-COMPLEX study was a secondary post hoc analysis of the 2,342 patients who underwent complex PCI in the larger, randomized, double-blind TWILIGHT trial who were assigned to ticagrelor monotherapy or to continued ticagrelor plus aspirin after 3 months of DAPT.

Disclosures: The TWILIGHT trial was funded by AstraZeneca. The presenter reported receiving institutional research grants from that company, as well as from Bayer and Daichi-Sankyo. He also served as a paid consultant to Abbott Vascular, Boston Scientific, and Biosensors.


Dangas GD. ACC 2020, Abstract 410-09.