Antiplatelet Therapy in Patients with Coronary Disease and Type 2 Diabetes

This editorial reviews the findings of the THEMIS trial, part of the PARTHENON clinical development program, which evaluated ticagrelor in patients with type 2 diabetes and coronary artery disease. The study demonstrated a modest reduction in cardiovascular events (7.7% vs. 8.5%; hazard ratio, 0.90; 95% CI, 0.81–0.99) with ticagrelor added to aspirin, but this benefit was offset by an increased risk of major bleeding (2.2% vs. 1.0%; hazard ratio, 2.32; 95% CI, 1.82–2.94). The editorial contextualizes these results within broader evidence from trials like ASCEND and PEGASUS TIMI 54, highlighting the trade-off between ischemic event reduction and bleeding risk. It concludes that for most patients with type 2 diabetes and stable coronary disease, the addition of ticagrelor to aspirin is not recommended due to the unfavorable risk-benefit ratio.

This editorial reviews the findings of the THEMIS trial, part of the PARTHENON clinical development program, which evaluated ticagrelor in patients with type 2 diabetes and coronary artery disease. The study demonstrated a modest reduction in cardiovascular events (7.7% vs. 8.5%; hazard ratio, 0.90; 95% CI, 0.81–0.99) with ticagrelor added to aspirin, but this benefit was offset by an increased risk of major bleeding (2.2% vs. 1.0%; hazard ratio, 2.32; 95% CI, 1.82–2.94). The editorial contextualizes these results within broader evidence from trials like ASCEND and PEGASUS TIMI 54, highlighting the trade-off between ischemic event reduction and bleeding risk. It concludes that for most patients with type 2 diabetes and stable coronary disease, the addition of ticagrelor to aspirin is not recommended due to the unfavorable risk-benefit ratio.