A 55-year-old diabetic male post-NSTEMI is being considered for dual antiplatelet therapy. He had a GI bleed 8 months ago. The PEGASUS-TIMI 54 trial evaluated which specific therapeutic strategy?
- A Rivaroxaban added to dual antiplatelet therapy in ACS patients
- B Extended use of ticagrelor (60 mg twice daily) beyond 1 year after MI in high-risk patients ✓
- C Prasugrel vs. ticagrelor head-to-head comparison post-NSTEMI
- D Vorapaxar added to aspirin monotherapy for secondary prevention
Correct answer: B. Extended use of ticagrelor (60 mg twice daily) beyond 1 year after MI in high-risk patients
Explanation
PEGASUS-TIMI 54 (NEJM 2015) evaluated ticagrelor 60 mg bd or 90 mg bd versus placebo added to aspirin in stable post-MI patients (1–3 years from event). The 60 mg twice-daily dose reduced composite of CV death, MI, stroke (7.77% vs. 9.04%) with acceptable bleeding risk and achieved FDA approval for long-term secondary prevention. Rivaroxaban added to DAPT was studied in ATLAS ACS 2-TIMI 51. Vorapaxar (PAR-1 antagonist) was assessed in TRA 2°P-TIMI 50. PEGASUS specifically addressed extended therapy beyond 12 months.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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