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TWILIGHT Benefits of Dropping Aspirin Hold Up in Diabetes

Discontinuing aspirin after 3 months on a background of ticagrelor (Brilinta, Brilique; AstraZeneca) reduced clinically relevant bleeding but also resulted in numerically fewer ischemic complications than taking both agents for 1 year in the TWILIGHT-DM study. TWILIGHT-DM focused on 2620 high-risk patients with diabetes (mean age, 64.8 years) in the parent TWILIGHT trial. Over 1-year follow-up in the intention-to-treat cohort, the rate of BARC 2, 3 or 5 bleeding was 4.5% in the ticagrelor plus placebo group and 6.7% in the ticagrelor plus aspirin group (hazard ratio [HR], 0.65; P = 0.01).Ticagrelor monotherapy was not associated with an increase in ischemic events compared with ticagrelor plus aspirin (4.6% vs 5.9%; HR 0.77; 95% CI 0.55 to 1.09; p=0.14).

However, the authors of the study emphasize that the results obtained should not be extrapolated to tactics in relation to clopidogrel.


Source: 1.

               2. Dominick J. Angiolillo, Usman Baber, Samantha Sartor et al. Ticagrelor with or without Aspirin in High-Risk Patients with Diabetes Mellitus undergoing Percutaneous Coronary Intervention. Journal of the American College of Cardiology. March 2020. DOI: 0.1016/j.jacc.2020.03.008