An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• High bleeding rates persist with dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI), especially in acute coronary syndrome (ACS) or high bleeding risk patients.
• Aspirin-free strategies may lower early bleeding post-PCI without compromising cardiovascular outcomes, but require validation in randomized trials.

Purpose of the Study:

• To evaluate the efficacy and safety of an aspirin-free prasugrel monotherapy strategy compared to DAPT in patients undergoing PCI.
• To assess superiority for major bleeding and noninferiority for cardiovascular events within one month post-PCI.

Main Methods:

• A randomized trial involving 6002 patients with ACS or high bleeding risk undergoing PCI.
• Patients were assigned to either prasugrel monotherapy (no-aspirin group) or DAPT (aspirin plus prasugrel).
• Coprimary endpoints included major bleeding and a composite of cardiovascular events.

Main Results:

• The aspirin-free group was not superior in reducing major bleeding (4.47% vs. 4.71%) but was noninferior for cardiovascular events (4.12% vs. 3.69%) at 1 month.
• No significant differences were observed in net adverse clinical outcomes or individual cardiovascular event components.
• The no-aspirin group showed a higher incidence of unplanned coronary revascularization and subacute stent thrombosis.

Conclusions:

• An aspirin-free strategy with low-dose prasugrel did not achieve superiority for major bleeding post-PCI compared to DAPT.
• The aspirin-free strategy was noninferior for cardiovascular events but carried a signal of increased coronary events, including stent thrombosis.