Early Aspirin Discontinuation Postacute Coronary Syndrome: A New Approach to Postmyocardial Infarction Management

Dual antiplatelet therapy with aspirin and a P2Y 12 inhibitor for 12 months has long been the official guideline for patients with acute coronary syndrome treated with percutaneous coronary intervention. There have been recent trials and analyses looking at modifying this recommendation due to the fact that although it reduces risk for thrombosis, it increases risk for major bleeding events. This literature review synthesizes those studies and evaluates whether discontinuing aspirin and moving to P2Y 12 monotherapy can reduce bleeding without increasing ischemic events, as well as the optimal time to do so. The evidence discussed demonstrated that aspirin discontinuation generally reduced bleeding compared with continued dual antiplatelet therapy, while cardiovascular outcomes were not clearly increased in selected patients. These findings are strongest for lower-risk acute coronary syndrome patients while myocardial infarction-specific evidence is more limited and requires more investigation. Overall, discontinuing aspirin at either 3 or 1 month postpercutaneous coronary intervention appears to be a promising strategy to reduce bleeding risk while maintaining protection against thrombotic or cardiovascular events. However, timing needs to be individualized based on the bleeding and ischemic risk of the patient.