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Improving on current guidelines for aspirin-free strategies after percutaneous coronary intervention and future

Antonio Landi1,2, Michele A Karaboue3, Leonardo De Luca4

  • 1Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) Lugano, Switzerland.

Expert Review of Cardiovascular Therapy
|October 17, 2025
PubMed

Insights

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is shifting towards P2Y₁₂ inhibitor monotherapy, especially for high bleeding risk patients. Early aspirin cessation is recommended to minimize bleeding events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Technological advances in PCI and recognition of bleeding risks have prompted DAPT strategy modulation.
  • Current guidelines emphasize balancing antithrombotic efficacy with bleeding avoidance post-PCI.

Purpose of the Study:

  • To review current DAPT modulation strategies for patients undergoing PCI.
  • To focus on acute coronary syndromes (ACS) and chronic coronary syndromes (CCS) patients, stratified by bleeding risk.

Main Methods:

  • Systematic literature search of PubMed, Web of Science, and Cochrane Library databases.
  • Review focused on DAPT intensity and duration strategies post-PCI.
  • Analysis stratified by patient subgroups (ACS, CCS, high bleeding risk).

Main Results:

  • Evidence supports early aspirin discontinuation and P2Y₁₂ inhibitor monotherapy, particularly in high bleeding risk patients.
  • Ticagrelor monotherapy shows promise in ACS patients; clopidogrel may suit CCS or low-risk patients.
  • A personalized approach to DAPT selection and duration is crucial.

Conclusions:

  • The antithrombotic paradigm post-PCI is evolving towards de-escalation of DAPT.
  • Tailoring therapy based on individual patient risk (thrombotic and bleeding) is essential for optimal outcomes.
  • P2Y₁₂ inhibitor monotherapy represents a key strategy for selected patients.
Abstract

Keywords:
Antithrombotic therapyacute coronary syndromechronic coronary syndromecoronary artery diseasepercutaneous coronary intervention

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