Short-Term Dual Antiplatelet Therapy With Early Transi-tion to Low-dose Antiplatelet Monotherapy Using Ti-cagRelor in Chronic Coronary Artery Disease

Short-Term Dual Antiplatelet Therapy With Early Transition to Low-dose Antiplatelet Monotherapy Using ticagRelor in Chronic Coronary Artery Disease

This is a prospective, multicenter, randomized, open-label trial with blinded endpoint adjudication (PROBE design), comparing one-month dual antiplatelet therapy (DAPT) with low-dose ticagrelor (60 mg BID) followed by ticagrelor monotherapy to standard 6-month DAPT with aspirin and clopidogrel in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). The primary endpoint is a composite of cardiovascular death, all-cause death, myocardial infarction, disabling stroke, target lesion revascularization (TLR), and major bleeding. The study aims to evaluate whether the short DAPT strategy reduces ischemic events while maintaining bleeding safety.

Inclusion Criteria:

• Age ≥18 years at the time of informed consent.
• Diagnosis of chronic coronary syndrome (CCS) according to ESC guidelines.
• Undergoing successful PCI with implantation of one or more new-generation drug-eluting stents (DES).
• Indication for dual antiplatelet therapy (DAPT) following PCI.
• Willingness and ability to comply with all study procedures and follow-up assessments.
• Signed informed consent prior to any study-specific procedure.
• Creatinine clearance ≥30 mL/min, calculated using the Cockcroft-Gault formula.
• Life expectancy greater than 1 year in the investigator's judg-ment.
• Hemodynamically stable at the time of randomization.
• Acceptable bleeding risk profile: patients fulfilling ARC-HBR criteria may be included only if the treating physician deems a 6-month antiplatelet regimen to be safe.
• No contraindications to study drugs, including aspirin, clopi-dogrel, or ticagrelor.

Exclusion Criteria:

• Presentation with acute coronary syndrome (ACS), including STEMI, NSTEMI, or unstable angina within the previous 6 mon-ths.
• Planned staged PCI or revascularization procedure within 6 months after index PCI.
• Requirement for long-term oral anticoagulation therapy, such as for atrial fibrillation, mechanical heart valves, or venous thromboembolism.
• History of major bleeding, including gastrointestinal or intra-cranial bleeding, within the past 6 months.
• Severe hepatic impairment, active liver disease, or transamina-ses >3× upper limit of normal.
• Known platelet disorder, coagulopathy, or thrombocytopenia (<100,000/mm³).
• Contraindication or hypersensitivity to aspirin, clopidogrel, or ticagrelor, or known drug interaction that precludes their use.
• Ongoing active bleeding or high risk of bleeding that, in the opinion of the investigator, precludes DAPT.
• Pregnancy or breastfeeding, or women of childbearing potential who are not using effective contraception.
• Life expectancy <1 year due to non-cardiovascular comorbidi-ties (e.g., cancer, advanced renal failure).
• Participation in another interventional clinical trial that may interfere with the outcomes of this study.
• Severe anemia (hemoglobin <9 g/dL) not corrected before ran-domization.
• Inability or unwillingness to provide informed consent or ad-here to study follow-up.
• Prior stroke with residual neurological deficit or history of di-sabling stroke (mRS ≥3).