The study design and rationale for the TICO trial have been described in detail previously. Thus, the aims of the present post-hoc analysis of the TICO trial were: 1) to apply HBR by ARC-HBR criteria and PRECISE-DAPT score for clinical outcomes and 2) to investigate the impact of ticagrelor monotherapy after 3-month DAPT in HBR compared to non-HBR patients. 8), 9), 10) The Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus-eluting Stent for Acute Coronary Syndrome (TICO) trial demonstrated that ticagrelor monotherapy after 3-month DAPT was associated with a lower incidence of a composite outcome of major bleeding and adverse cardiac and cerebrovascular events at 1 year than currently recommended ticagrelor-based 12-month DAPT in ACS patients treated with drug eluting stents (DESs). 5), 6), 7) Furthermore, newer antiplatelet agents, such as ticagrelor or prasugrel, with better speed, potency, and consistent effect have become available, and ticagrelor monotherapy after short-term DAPT may minimize bleeding risk without increasing ischemic risk. 3), 4) Studies have shown that HBR by these 2 definitions is associated with increased risk of both bleeding and ischemic events. 1), 2), 3) Recently, 2 definitions for HBR, the Academic Research Consortium for HBR (ARC-HBR) criteria and the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score, have been proposed to provide consistency in defining HBR and aid clinical decision-making for patients undergoing PCI. In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), identifying and managing patients with high bleeding risk (HBR) are of major concern since prolonged 12-month dual antiplatelet therapy (DAPT) with aspirin and P2Y 12 receptor inhibitor is recommended.
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