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[Which antiplatelet therapy and how long in the first year after an acute coronary syndrome?]

Luigi Oltrona Visconti1, Antonio Landi2, Marco Ferlini3

  • 1Casa di Cura La Madonnina, Gruppo San Donato, Milano.

Giornale Italiano Di Cardiologia (2006)
|May 27, 2026
PubMed

Insights

Aspirin-free strategies using P2Y12 inhibitors alone after acute coronary syndrome (ACS) show promise. Reducing dual antiplatelet therapy duration may lower bleeding risk without increasing ischemic events.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard post-acute coronary syndrome (ACS) to prevent ischemia.
  • Current guidelines recommend 12 months of DAPT after percutaneous coronary intervention (PCI).
  • Bleeding complications carry significant mortality risks, similar to or exceeding recurrent myocardial infarction.

Purpose of the Study:

  • To review literature on aspirin-free antiplatelet strategies.
  • To evaluate recent trial results on P2Y12 inhibitor monotherapy after ACS and PCI.

Main Methods:

  • Literature review of recent clinical trials.
  • Analysis of studies comparing DAPT duration and P2Y12 inhibitor monotherapy versus DAPT.

Main Results:

  • Several trials have investigated reducing DAPT duration or using P2Y12 inhibitor monotherapy post-PCI.
  • These studies challenge the traditional 12-month DAPT recommendation.

Conclusions:

  • Aspirin-free strategies, particularly P2Y12 inhibitor monotherapy, are emerging as viable alternatives.
  • These approaches may balance ischemic event prevention with reduced bleeding risk in ACS patients undergoing PCI.

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