Optimizing Monotherapy Selection, Aspirin Versus P2Y12 Inhibitors, Following Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is crucial after percutaneous coronary intervention (PCI) to prevent thrombotic events.
• Historically, 12-month DAPT was recommended post-PCI, but concerns regarding bleeding complications persist.
• Advances in stent technology and antiplatelet agents have improved ischemic event reduction, prompting re-evaluation of DAPT duration.

Purpose of the Study:

• To review major clinical trials evaluating short-duration DAPT strategies.
• To compare the efficacy and safety of aspirin monotherapy versus P2Y12 inhibitor monotherapy after abbreviated DAPT.
• To propose an individualized treatment algorithm for post-PCI antiplatelet therapy selection.

Main Methods:

• Systematic review of randomized controlled trials investigating short-duration DAPT regimens.
• Analysis of studies comparing aspirin monotherapy vs. P2Y12 inhibitor monotherapy post-PCI.
• Evaluation of patient-level data to stratify risk for different monotherapy strategies.

Main Results:

• Short-duration DAPT followed by P2Y12 inhibitor monotherapy is safe and effective in low-risk populations, reducing bleeding without increasing ischemic events.
• Aspirin monotherapy after short DAPT may be suitable for select low-risk patients.
• For intermediate- to high-risk patients, continuing P2Y12 inhibitor monotherapy after short DAPT appears to be the optimal strategy to balance efficacy and safety.

Conclusions:

• Individualized DAPT duration is essential post-PCI, considering patient-specific risk factors.
• P2Y12 inhibitor monotherapy following a short DAPT course is a preferred strategy for intermediate- to high-risk patients to minimize bleeding.
• Further research may refine risk stratification and optimize monotherapy selection after PCI.