The Yin and Yang of Long-Term Dual Antiplatelet Therapy

For the 60-mg dose, the absolute risk difference for the ischemic primary endpoint was -1.27%, favoring ticagrelor, and the incidence of TIMI major bleeding was 1.24%, favoring placebo. [...]if the ischemic and bleeding primary endpoints are given equal weight, 90 mg of ticagrelor twice daily in this patient population results in a small net harm. The bleeding risk in this setting is unlikely to exceed the rate of ischemic events at 2 and 5 years. [...]the challenge now is how to identify these very high-risk populations so that patients likely to benefit from prolonged dual antiplatelet therapy are targeted for treatment.