Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial

Lancet
Pascal VranckxGLOBAL LEADERS Investigators

Abstract

We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed...Continue Reading

Citations

Dec 7, 2018·Circulation Journal : Official Journal of the Japanese Circulation Society·Yasutsugu Shiono, Takashi Akasaka
Jan 3, 2019·European Heart Journal·Dariusz DudekWilliam Wijns
Jan 3, 2019·European Heart Journal·Petr WidimskyThomas F Lüscher
Mar 6, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Hidenori KomiyamaPatrick W Serruys
May 31, 2019·European Heart Journal·Paul A GurbelUdaya S Tantry
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Aug 10, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Davide Capodanno
Jun 21, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Ply ChichareonPatrick W Serruys
Apr 24, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Norihiro KogameUNKNOWN Collaborators
Aug 15, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Norihiro KogamePatrick W Serruys
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Sep 3, 2019·The New England Journal of Medicine·P Gabriel StegUNKNOWN THEMIS Steering Committee and Investigators
Nov 19, 2019·Annals of Internal Medicine·Alexander Gallus
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Jan 21, 2020·Platelets·William A E Parker, Robert F Storey
Oct 8, 2019·Internal Medicine·Yuichi Saito, Yoshio Kobayashi
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