Early Aspirin Discontinuation After Coronary Stenting: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials & Meta-Analysis

Background:

• The clinical impact of early aspirin discontinuation versus dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) with stenting is not well-established.
• Understanding optimal antiplatelet strategies is crucial for balancing ischemic event prevention and bleeding risk.
• Existing research lacks comprehensive comparisons of these two therapeutic approaches.

Purpose of the Study:

• To investigate and compare the clinical outcomes of early aspirin discontinuation versus DAPT in patients who have undergone PCI with stenting.
• To evaluate the impact of these strategies on all-cause death, myocardial infarction, stent thrombosis, stroke, and major bleeding.

Main Methods:

• A meta-analysis of aggregate data from seven randomized clinical trials was conducted.
• Included trials enrolled patients receiving PCI with stenting, randomized to either early aspirin discontinuation or DAPT.
• Data from 36,206 participants were pooled, with a median follow-up of 12 months, using random effects models.

Main Results:

• No significant differences were observed in all-cause death (HR, 0.91), myocardial infarction (HR, 1.02), stent thrombosis (HR, 1.02), or stroke (HR, 1.01) between the early aspirin discontinuation and DAPT groups.
• The risk of major bleeding was significantly reduced in the early aspirin discontinuation group compared to the DAPT group (HR, 0.58; P<0.01).
• A total of 18,088 patients were assigned to early aspirin discontinuation and 18,118 to DAPT.

Conclusions:

• In patients undergoing PCI with stenting, early aspirin discontinuation demonstrates a similar risk profile for death and ischemic events when compared to DAPT.
• A significant reduction in major bleeding risk is achieved with early aspirin discontinuation.
• This suggests that early aspirin discontinuation may be a favorable strategy for select patients post-PCI to minimize bleeding complications without compromising efficacy.