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October 17, 2025Expert Review of Cardiovascular Therapy

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

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Key result

Early aspirin discontinuation and transition to P2Y12 monotherapy is supported in high bleeding risk patients post-PCI.

Why the study?

Advancements in PCI devices and recognition of post-PCI bleeding risks have motivated investigation into modulating the intensity and duration of DAPT.

Does early aspirin discontinuation and transitioning to P2Y12 inhibitor monotherapy improve outcomes in patients with ACS or CCS undergoing PCI?

Population

ACS or CCS patients undergoing PCI stratified by HBR features

Design

Review

Authors

ALAntonio LandiMKM KaraboueLLLeonardo De Luca

Discussion

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Member takes

Overview

May support early aspirin discontinuation in high-bleeding-risk post-PCI patients; leaves open confirmation by dedicated RCTs.

Structured PICO

Does early aspirin discontinuation and transitioning to P2Y12 inhibitor monotherapy improve outcomes in patients with ACS or CCS undergoing PCI?

P
Population
Patients with acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) undergoing percutaneous coronary intervention (PCI), stratified by the presence of high bleeding risk (HBR) features.
I
Intervention
Early aspirin discontinuation and transitioning to P2Y12 inhibitor monotherapy (ticagrelor or clopidogrel).

A patient-centered approach favoring early aspirin discontinuation and P2Y12 inhibitor monotherapy is supported by current evidence for post-PCI patients, particularly those at high bleeding risk.

Cite This Study

Landi et al. (2025) conducted a review in Acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) undergoing PCI. Early aspirin discontinuation and P2Y12 inhibitor monotherapy vs. Standard dual antiplatelet therapy was evaluated. Early aspirin discontinuation and transitioning to P2Y12 inhibitor monotherapy is supported by current evidence, particularly in patients with high bleeding risk after percutaneous coronary intervention.

synapsesocial.com/papers/6a07b41644ff8ad339f69a7bhttps://doi.org/10.1080/14779072.2025.2569398
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Defining Strategies of Modulation of Antiplatelet Therapy in Patients With Coronary Artery Disease: A Consensus Document from the Academic Research Consortium2023 · 179 citations
  2. 2Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk2022 · 35 citations
  3. 3Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials2015 · 329 citations
  4. 4Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk2021 · 588 citations
  5. 5PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY2020 · 63 citations