P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention
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Updated: Aug 24, 2025
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Published on: March 15, 2022
Xuan Zhou1,2, Dominick J Angiolillo1, Luis Ortega-Paz1
1Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
Insights
Dual antiplatelet therapy (DAPT) reduces clots but increases bleeding after percutaneous coronary intervention (PCI). P2Y12 inhibitor monotherapy offers a safer alternative, potentially reducing bleeding risks in patients undergoing PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) for coronary artery disease.
- While effective against thrombosis, DAPT significantly increases bleeding risk, linked to poorer patient outcomes.
- Advancements in drug-eluting stents and potent P2Y12 inhibitors prompt re-evaluation of DAPT duration.
Purpose of the Study:
- To review current evidence on P2Y12 inhibitor monotherapy versus DAPT after PCI.
- To evaluate the safety and efficacy of P2Y12 inhibitor monotherapy compared to aspirin for long-term prevention post-PCI.
Main Methods:
- Review of recent clinical trials assessing P2Y12 inhibitor monotherapy after short DAPT courses in PCI patients.
- Analysis of studies comparing P2Y12 inhibitor monotherapy against DAPT and aspirin for long-term prevention.
Main Results:
- Several trials indicate favorable safety and efficacy profiles for P2Y12 inhibitor monotherapy after abbreviated DAPT.
- Ongoing research explores immediate P2Y12 inhibitor monotherapy post-PCI in select patient groups.
- Comparisons highlight potential benefits of P2Y12 inhibitor monotherapy over aspirin for long-term prevention.
Conclusions:
- P2Y12 inhibitor monotherapy, following a short DAPT course, presents a promising alternative to standard DAPT after PCI.
- Further research is needed to define optimal strategies for P2Y12 inhibitor monotherapy, including immediate use post-PCI.
- Monotherapy may offer a superior risk-benefit balance, reducing bleeding while maintaining adequate thrombotic protection.
Abstract:
In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk of bleeding, which is independently associated with poor prognosis. The improvement of the safety profiles of drug-eluting stents has been critical in investigating and implementing shorter DAPT regimens. The introduction into clinical practice of newer generation oral P2Y12 inhibitors such as prasugrel and ticagrelor, which provide more potent and predictable platelet inhibition, has questioned the paradigm of standard DAPT durations after coronary stenting. Over the last five years, several trials have assessed the safety and efficacy of P2Y12 inhibitor monotherapy after a short course of DAPT in patients treated with PCI. Moreover, ongoing studies are testing the role of P2Y12 inhibitor monotherapy immediately after PCI in selected patients. In this review, we provide up-to-date evidence on the efficacy and safety of P2Y12 inhibitor monotherapy after a short period of DAPT compared to DAPT in patients undergoing PCI as well as outcomes associated with P2Y12 inhibitor monotherapy compared to aspirin for long-term prevention.
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