Key result
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.
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?
Does early aspirin discontinuation and transitioning to P2Y12 inhibitor monotherapy improve outcomes in patients with ACS or CCS undergoing PCI?
Answers are grounded in this paper and cite their sources.
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.
INTRODUCTION: In the last decade, technological advancements in procedural devices and techniques as the increasing recognition of the prognostic relevance of bleeding after percutaneous coronary intervention (PCI) paved the way forward to the investigation of different modulation strategies of dual antiplatelet therapy (DAPT) intensity and duration. AREAS COVERED: The present review provides an update overview on DAPT modulation strategies with a specific focus in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) patients undergoing PCI stratified by the presence of high bleeding risk (HBR) features. We searched PubMed (MEDLINE), Web of Science and Cochrane Library databases from inception to August 2025 using combinations of appropriate keywords. EXPERT OPINION: Current evidence supports a shift in the post-PCI antithrombotic paradigm toward early aspirin discontinuation and transitioning to P2Y₁₂ inhibitor monotherapy, particularly in patients with HBR. While there is increasing evidence for ticagrelor monotherapy in patients with ACS, clopidogrel-based strategies may be considered in selected patients, particularly those with CCS and/or or low thrombotic risk. A patient-centered, tailored approach should remain key to guide the selection and duration of antiplatelet therapy after PCI.
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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.
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