The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y₁₂ Inhibitor in Patients After...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor reduces major adverse cardiovascular events (MACE) post-percutaneous coronary intervention (PCI) but increases bleeding risk.
• The safety and efficacy of discontinuing aspirin in favor of P2Y12 inhibitor monotherapy after PCI remain subjects of clinical debate.

Purpose of the Study:

• To evaluate the safety and efficacy of discontinuing aspirin 1 to 3 months after PCI, continuing only a P2Y12 inhibitor, compared to traditional DAPT.

Main Methods:

• A meta-analysis of randomized controlled trials (2001-2020) was performed.
• Included trials compared aspirin discontinuation (1-3 months post-PCI) with P2Y12 inhibitor monotherapy against traditional DAPT.
• Primary outcomes were bleeding events and MACE, with follow-up ranging from 12 to 15 months.

Main Results:

• Discontinuing aspirin 1-3 months post-PCI significantly reduced major bleeding by 40% (HR, 0.60) without increasing MACE (HR, 0.88).
• In patients with acute coronary syndrome, aspirin discontinuation reduced bleeding by 50% (HR, 0.50) and did not increase MACE (HR, 0.85).
• No significant increase in myocardial infarction or death was observed in the aspirin discontinuation group.

Conclusions:

• Discontinuing aspirin 1-3 months after PCI, while continuing P2Y12 inhibitor monotherapy, effectively reduces bleeding risk.
• This strategy does not appear to increase the risk of MACE, even in patients with acute coronary syndrome.