Why the study?
Standard 12 months of DAPT after PCI increases bleeding risk, prompting investigation into whether novel P2Y12 inhibitors can be used in aspirin-free antiplatelet regimens to improve clinical outcomes.
Does early cessation of aspirin followed by P2Y12 inhibitor monotherapy post-PCI reduce bleeding without increasing ischemic events compared to standard 12-month DAPT?
Does early cessation of aspirin followed by P2Y12 inhibitor monotherapy post-PCI reduce bleeding without increasing ischemic events compared to standard 12-month DAPT?
Relative Risk: 0.87 (95% CI 0.75–1.01)
Absolute Event Rate: 3.81% vs 4.37%
p-value: p=0.073
Early discontinuation of aspirin with continued P2Y12 inhibitor monotherapy following PCI shows promise in reducing major bleeding without increasing ischemic risk, particularly in high-risk patients, challenging standard 12-month DAPT guidelines.
Historically, aspirin has been the primary treatment for the prevention of ischaemic events in patients with coronary artery disease. For patients undergoing percutaneous coronary intervention (PCI) standard treatment has been 12 months of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, followed by aspirin monotherapy; however, DAPT is undeniably associated with an increased risk of bleeding. For over a decade novel P2Y12 inhibitors, which have increased specificity, potency, and efficacy have been available, prompting studies which have tested whether these newer agents can be used in aspirin-free antiplatelet regimens to augment clinical benefits in patients post-PCI. Among these studies, the GLOBAL LEADERS trial is the largest by cohort size, and so far has provided a wealth of evidence in a variety of clinical settings and patient groups. This article summarizes the state-of-the-art evidence obtained from the GLOBAL LEADERS and other trials of aspirin-free strategies.
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Wang et al. (2021) conducted a review in Coronary artery disease post-PCI (n=15,968). Ticagrelor monotherapy vs. Standard 12-month DAPT followed by 12-month aspirin monotherapy was evaluated on Composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction (MI) at 2 years (RR 0.87, 95% CI 0.75-1.01, p=0.073).
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