Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial

RCT (n= 2697, South Korea) found unguided de-escalation antiplatelet strategy (switching from ticagrelor+aspirin [TA] to clopidogrel+aspirin) was superior to remaining on TA at preventing net adverse clinical events up to 12 months, mainly by reducing bleeding events.

SPS commentary:

The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or bleeding type 2, 3, or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months, which occurred in 59 [4.6%] on de-escalation antiplatelet strategy vs 104 [8.2%], on active control [p for non-inferiority<0·001; HR 0.55; 95% CI 0.40–0.76, p for superiority = 0·0001).

The Lancet