The optimal antiplatelet approach for PAD remains uncertain. Findings presented at the American Heart Association (AHA) 2025 Scientific Sessions evaluated whether ticagrelor plus aspirin provides clinical benefit compared with monotherapy with either antiplatelet agent.
The meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included studies published up to March 19, 2025. The search identified three randomized controlled trials (RCTs) from 280 screened studies, enrolling 1,702 patients with PAD. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic.
Dual therapy did not improve major outcomes. Myocardial infarction showed no significant difference (HR 1.18, 95% CI 0.70–1.96; p=0.54). Mortality rates were similar (HR 0.73, 95% CI 0.49–1.08; p=0.12). Limb ischemia approached but did not reach significance (HR 0.64, 95% CI 0.39–1.05; p=0.08). Hemorrhagic events were comparable (HR 1.27, 95% CI 0.32–4.99; p=0.74).
This analysis represents the first pooled evaluation comparing ticagrelor–aspirin dual therapy with monotherapy in PAD. The absence of measurable benefit suggests that monotherapy remains appropriate for many patients with PAD. Additional RCTs are needed to clarify whether specific subgroups may benefit from combined therapy.
