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Study protocol for low-dose evaluation of aspirin in patients with ST-elevation myocardial infarction undergoing

Wen Zheng1, Zhao-Ting Gong1, Hai-Yan Qian1

  • 1Center for Coronary Artery Disease, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Annals of Medicine
|November 24, 2025
PubMed

Insights

This study investigates low-dose versus standard-dose aspirin in Chinese ST-elevation myocardial infarction (STEMI) patients on dual antiplatelet therapy. Findings aim to optimize aspirin maintenance dose for better efficacy and safety in East Asian populations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is standard for ST-elevation myocardial infarction (STEMI).
  • Optimal aspirin maintenance dose is debated, especially in East Asian populations with higher bleeding sensitivity.
  • Standard DAPT regimens may pose increased bleeding risks in specific ethnic groups.

Purpose of the Study:

  • To determine the optimal aspirin maintenance dose in Chinese STEMI patients receiving ticagrelor.
  • To evaluate the balance between ischemic events and bleeding risk with different aspirin doses.
  • To inform population-specific antithrombotic strategies for acute coronary syndrome.

Main Methods:

  • The Low-dose Evaluation of Aspirin (LEAST) trial is a multicenter, randomized, double-blind, placebo-controlled study.
  • 3612 Chinese STEMI patients post-percutaneous coronary intervention will be randomized.
  • Comparing low-dose (50 mg/d) vs. standard-dose (100 mg/d) aspirin with ticagrelor (90 mg twice daily).

Main Results:

  • Primary endpoint: 12-month composite of cardiac death, MI, stroke, or revascularization (non-inferiority).
  • Secondary endpoint: Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (superiority).
  • Hierarchical testing ensures bleeding benefits are claimed only if ischemic safety is established.

Conclusions:

  • The LEAST trial will provide crucial evidence on aspirin dosing for Chinese STEMI patients.
  • Findings may lead to tailored antithrombotic strategies for East Asian populations.
  • Results could influence future guideline recommendations for acute coronary syndrome management.
Abstract

Keywords:
Dual antiplatelet therapyEast AsianST-elevation myocardial infarctionaspirinbleedingpercutaneous coronary interventionprotocolrandomized controlled trialticagrelor

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