Basit A, Aslam MH, Anwar MM, Sarwar MA, Akram A, Ismail Q, Iftikhar A, Haq M. Re-evaluating aspirin in the era of potent P2Y12 inhibitors: Ticagrelor monotherapy after percutaneous coronary intervention. World J Pharmacol 2026; 15(2): 115880 [DOI: 10.5497/wjp.115880]
Corresponding Author of This Article
Majeed Haq, Department of Pharmacology, Shaheed Suhrawardy Medical College and Hospital, Sher-E-Bangla Nagar, Dhaka 1207, Bangladesh. b0807621@gmail.com
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Basit A, Aslam MH, Anwar MM, Sarwar MA, Akram A, Ismail Q, Iftikhar A, Haq M. Re-evaluating aspirin in the era of potent P2Y12 inhibitors: Ticagrelor monotherapy after percutaneous coronary intervention. World J Pharmacol 2026; 15(2): 115880 [DOI: 10.5497/wjp.115880]
World J Pharmacol. Sep 16, 2026; 15(2): 115880 Published online Sep 16, 2026. doi: 10.5497/wjp.115880
Re-evaluating aspirin in the era of potent P2Y12 inhibitors: Ticagrelor monotherapy after percutaneous coronary intervention
Abdul Basit, Muhammad Hamza Aslam, Muhammad Moneeb Anwar, Muhammad Ahmad Sarwar, Ammara Akram, Qamar Ismail, Abdullah Iftikhar, Majeed Haq
Abdul Basit, Muhammad Moneeb Anwar, Qamar Ismail, Abdullah Iftikhar, Department of Pharmacology, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Muhammad Hamza Aslam, Department of Pharmacology, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College Lahore, Lahore 54000, Punjab, Pakistan
Muhammad Ahmad Sarwar, Department of Pharmacology, Pakistan Kidney and Liver Institute and Research Center, Lahore 54000, Punjab, Pakistan
Ammara Akram, Department of Pharmacology, Poonch Medical College, Rawalakot 12350, Pakistan
Majeed Haq, Department of Pharmacology, Shaheed Suhrawardy Medical College and Hospital, Dhaka 1207, Bangladesh
Author contributions: Basit A gave study conception and participated in manuscript revision and proofreading; Basit A, Aslam MH, Anwar MM, Sarwar MA, Akram A, Ismail Q, Iftikhar A, and Haq M analyzed the data, wrote the manuscript; Aslam MH, Anwar MM, Sarwar MA, and Akram A reviewed the manuscript thoroughly; Ismail Q, Iftikhar A, and Haq M did data extraction.
AI contribution statement: AI tools (Grammarly) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Majeed Haq, Department of Pharmacology, Shaheed Suhrawardy Medical College and Hospital, Sher-E-Bangla Nagar, Dhaka 1207, Bangladesh. b0807621@gmail.com
Received: October 29, 2025 Revised: February 2, 2026 Accepted: February 25, 2026 Published online: September 16, 2026 Processing time: 318 Days and 15.4 Hours
Abstract
BACKGROUND
High-risk patients undergoing percutaneous coronary intervention (PCI) need effective antiplatelet therapy to prevent thrombotic events, but prolonged dual antiplatelet therapy (DAPT) raises bleeding risk. Evidence suggests that early aspirin discontinuation with ticagrelor monotherapy may reduce bleeding without compromising ischemic protection.
AIM
To assess the efficacy and safety of ticagrelor monotherapy vs continued DAPT in high-risk post-PCI patients through a systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS
MEDLINE/PubMed, Cochrane, Clinicaltrials.gov and trial registries were searched to August 2025 for RCTs evaluating ticagrelor monotherapy after ≤ 3 months of DAPT. Outcomes included clinically relevant bleeding (Bleeding Academic Research Consortium 2/3/5), major bleeding (Bleeding Academic Research Consortium 3/5 or thrombolysis in myocardial infarction major), major adverse cardiac events (death, myocardial infarction, stroke), and net adverse clinical events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models.
RESULTS
Four RCTs (TWILIGHT, TICO, T-PASS, ULTIMATE-DAPT; > 20000 participants) were included. Ticagrelor monotherapy significantly reduced clinically relevant bleeding (HR = 0.53, 95%CI: 0.44-0.65; I2 = 0%) and major bleeding (HR = 0.45, 95%CI: 0.28-0.71; I2 = 34%) without excess major adverse cardiac events (HR = 0.97, 95%CI: 0.79-1.17; I2 = 0%). Net adverse clinical event was also reduced (HR = 0.53, 95%CI: 0.44-0.65).
CONCLUSION
Ticagrelor monotherapy after abbreviated DAPT lowers bleeding without increasing ischemic events, providing a favorable net clinical benefit in high-risk PCI patients and supporting guideline trends toward shorter DAPT.
