Prolonged Dual Platelet Inhibition in Patients with Prior MI

Dual antiplatelet therapy after acute coronary syndromes is recommended for 1 year, but its benefit for longer periods is unknown. Reducing further ischemic events by inhibiting platelet activation needs to be weighed against the risk for drug-associated bleeding complications. In the industry-sponsored PEGASUS-TIMI 54 trial, 21,162 patients with myocardial infarction (MI) 1 to 3 years previously (median, 1.7 years) were randomized to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo.

Patients received low-dose aspirin and were followed for a median of 33 months; 83% had undergone percutaneous coronary intervention. Treatment discontinuation occurred in 32% of the 90-mg group, 29% of the 60-mg group, and 21% of the place…