Stopping aspirin 1 to 3 mo after PCI reduces bleeding without increasing MACE vs. continued DAPT

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI).
• Discontinuation of aspirin may reduce bleeding complications.
• The optimal duration and strategy for aspirin cessation in DAPT require further investigation.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of discontinuing aspirin on a background of a P2Y12 inhibitor in patients post-PCI.
• To evaluate the impact of aspirin discontinuation on ischemic and bleeding events.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials and observational studies.
• Inclusion of studies comparing aspirin discontinuation versus continuation in patients on P2Y12 inhibitor therapy after PCI.
• Assessment of outcomes including major adverse cardiovascular events and bleeding events.

Main Results:

• Aspirin discontinuation, while maintaining P2Y12 inhibitor therapy, was associated with a significant reduction in bleeding events.
• No significant increase in ischemic events (myocardial infarction, stroke, or cardiovascular death) was observed with aspirin discontinuation.
• The findings were consistent across various subgroups of patients.

Conclusions:

• Discontinuing aspirin in favor of P2Y12 inhibitor monotherapy after PCI is a safe and effective strategy.
• This approach can help mitigate bleeding risks without compromising ischemic protection.
• Clinical guidelines may consider recommending selective aspirin cessation in select patient populations post-PCI.