Aspirin Withdrawal Before 30 Days After PCI in Acute Coronary Syndrome and Early Myocardial Infarction Risk: A...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard post-percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
• While aspirin cessation after one month of DAPT is safe, its early withdrawal (within 30 days) post-PCI remains under investigation.
• Current guidelines recommend DAPT for a period, but optimal duration and early de-escalation strategies are debated.

Purpose of the Study:

• To evaluate the safety and efficacy of aspirin-free P2Y12 inhibitor monotherapy (MAPT) initiated within 30 days post-PCI compared to standard DAPT in ACS patients.
• To assess short-term (0-30 days) and longer-term (31 days to 12 months) outcomes, focusing on ischemic and bleeding events.
• To determine if early aspirin withdrawal impacts myocardial infarction, bleeding, or composite clinical outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) published through December 2025.
• Included studies compared aspirin-free P2Y12 inhibitor monotherapy (MAPT) initiated within 30 days post-PCI versus standard DAPT in ACS patients.
• Random-effects models were employed to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for various outcomes.

Main Results:

• Three RCTs involving 10,736 patients were analyzed.
• Within 30 days post-PCI, aspirin discontinuation was linked to a significantly higher risk of myocardial infarction (OR: 2.12; 95% CI: 1.31-3.44) and no reduction in bleeding.
• Longer-term follow-up showed MAPT significantly reduced bleeding and net adverse clinical events without increasing ischemic events.

Conclusions:

• Early aspirin discontinuation (within 30 days) following PCI in ACS patients increases myocardial infarction risk and does not decrease bleeding.
• The initial 30-day period post-PCI appears critical, characterized by heightened ischemic vulnerability.
• Routine aspirin withdrawal during this early phase requires careful consideration and should be interpreted with caution.