Key result
Early aspirin discontinuation cuts bleeding ~54% vs standard DAPT but increases stent thrombosis.
Why the study?
The study evaluated the efficacy and safety of early aspirin discontinuation followed by P2Y12 inhibitor monotherapy compared with standard DAPT in ACS patients undergoing PCI.
Does early aspirin discontinuation followed by P2Y12 inhibitor monotherapy reduce bleeding without increasing ischemic events compared to standard DAPT in ACS patients undergoing PCI?
Meta-Analysis (n=20,501)
Does early aspirin discontinuation followed by P2Y12 inhibitor monotherapy reduce bleeding without increasing ischemic events compared to standard DAPT in ACS patients undergoing PCI?
Relative Risk: 0.46 (95% CI 0.36–0.6)
p-value: p=<0.001
Early aspirin discontinuation after PCI in ACS patients significantly reduces bleeding but increases the risk of stent thrombosis, emphasizing the need to balance individual bleeding and thrombotic risks.
Purpose To evaluate the efficacy and safety of early aspirin discontinuation followed by P2Y12 inhibitor monotherapy versus standard dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods This systematic review and meta-analysis followed PRISMA 2020 guidelines and a prespecified protocol registered in PROSPERO (CRD420261293472). MEDLINE, Embase, Scopus, and CENTRAL were searched through December 2025 for randomized controlled trials comparing early aspirin discontinuation (≤ 3 months) with standard DAPT in ACS patients undergoing PCI with drug-eluting stents. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment (Cochrane RoB 2.0). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Results Seven trials including 20,501 patients (10,246 early discontinuation; 10,255 standard DAPT) were analyzed. Early aspirin discontinuation significantly reduced bleeding (RR, 0.46; 95% CI, 0.36–0.60; p < 0.001; I²=21.9%). There was no significant difference in major adverse cardiovascular events (RR, 0.98; 95% CI, 0.77–1.26) or in myocardial infarction, stroke, repeat revascularization, or all-cause mortality. However, early aspirin discontinuation was associated with an increased risk of stent thrombosis (RR, 1.72; 95% CI, 1.07–2.78). In trials with aspirin discontinuation within 1 month, bleeding reduction remained substantial, with numerically higher but nonsignificant ischemic outcomes. Conclusion In ACS patients undergoing PCI, early aspirin discontinuation reduces bleeding without a statistically significant increase in overall ischemic events; however, a significant increase in stent thrombosis was observed. These results support individualized decision-making, particularly favoring patients at high bleeding risk and low thrombotic risk treated with potent P2Y12 inhibitors. Further adequately powered studies focused on rare ischemic outcomes, including stent thrombosis, are warranted.
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Huu et al. (2026) conducted a meta-analysis in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=20,501). Early aspirin discontinuation (≤ 3 months) followed by P2Y12 inhibitor monotherapy vs. Standard dual antiplatelet therapy (DAPT) was evaluated on Bleeding (RR 0.46, 95% CI 0.36-0.60, p=<0.001). Early aspirin discontinuation significantly reduced bleeding (RR 0.46; 95% CI 0.36-0.60; p<0.001) but increased the risk of stent thrombosis (RR 1.72; 95% CI 1.07-2.78) compared to standard DAPT.
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