Omitting aspirin in PCI patients: Myth or reality?

In the current era of percutaneous coronary intervention (PCI), with the use of contemporary drug-eluting stents, refined techniques, and adjunctive pharmacotherapy, the role of aspirin peri-PCI remains undisputable. Beyond the initial period, dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y₁₂ receptor inhibitor for 6 months in stable coronary artery disease and 12 months in acute coronary syndromes is the standard of care. However, concerns regarding bleeding adverse events caused by aspirin have led to shortened DAPT duration or even omission of aspirin. Aspirin free-strategies have been increasingly encountered in several studies and showed a significant reduction in bleeding events, without any sign of increased ischemic risk. Individualization of DAPT duration particularly in high bleeding risk patients appears therefore mandatory, making aspirin not necessary in several cases. Moreover, recent randomized trials have shed light on how to treat PCI patients in the presence of concomitant anticoagulant treatment with P2Y₁₂ monotherapy and excluding aspirin. These aspirin-free strategies have been proved safer than the "older" standard triple antithrombotic treatment, without compromising safety. Ongoing studies may further dispel the myths and establish real facts regarding post-PCI-tailored treatment with or without aspirin.