Your patient KG has a history of atherothrombosis and a prior MI. If she is treated with ticagrelor + ASA instead of ASA alone, for which adverse event is she at greatest risk?

  1. TIMI bleeding
  2. ICH
  3. MI
  4. Stroke

Correct Answer: A


The PEGASUS trial examined if adding ticagrelor to standard antiplatelet therapy (low-dose aspirin) would reduce the incidence of major adverse cardiovascular events during long-term follow-up in patients with a history of MI. The researchers found that adding ticagrelor to low-dose ASA in stable patients with a history of MI did reduce the risk of CV death, MI and/or stroke. Adding ticagrelor increased the risk of TIMI major and minor bleeding, but not fatal bleeding or ICH. They examined both 60mg BID and 90mg BID doses; while both had similar efficacy, adverse events were more frequent in the 90mg group.


Bonaca MP, et al. Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction. N Engl J Med. 2015 Mar 14. [Epub ahead of print]

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