Key result
Early aspirin discontinuation after PCI reduces bleeding and improves net outcomes, despite modestly higher stent thrombosis.
Why the study?
The impact of timing of early aspirin discontinuation after PCI on clinical outcomes including bleeding, ischemic events, and stent thrombosis risk remains uncertain.
Does early aspirin discontinuation with P2Y12 inhibitor monotherapy improve clinical outcomes compared to continued DAPT in adults undergoing PCI?
Meta-Analysis
Does early aspirin discontinuation with P2Y12 inhibitor monotherapy improve clinical outcomes compared to continued DAPT in adults undergoing PCI?
Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without increasing most ischemic risks, though it modestly increases stent thrombosis, with timing (0-90 days) not significantly modifying these effects.
Immediate aspirin cessation post-PCI increases MI; 1–3 month discontinuation reduces bleeding without ischemic trade-off, refining risk-aligned timing for practice and trials.
Background: Early aspirin discontinuation followed by P2Y12 inhibitor monotherapy is increasingly used after percutaneous coronary intervention (PCI), yet whether the timing of discontinuation within the early post-procedural period modifies clinical outcomes remains uncertain. Methods: We searched PubMed/MEDLINE, Scopus, Embase, CENTRAL, and ClinicalTrials.gov through March 5, 2026, for randomized controlled trials evaluating early aspirin discontinuation with P2Y12 inhibitor monotherapy versus continued dual antiplatelet therapy (DAPT) in adults undergoing PCI. Outcomes included major bleeding, stent thrombosis, myocardial infarction (MI), major adverse cardiovascular events (MACE), all-cause mortality, ischemic stroke, and net adverse clinical events (NACE). Results: = 0%), with a directional gradient from HR 1.62 at 0 days to HR 0.81 at 90 days. Meta-regression found no significant association between discontinuation timing and any outcome (all p > 0.05). Hartung-Knapp sensitivity analysis did not materially alter pooled estimates. Conclusions: Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without significant increases in MI, MACE, or mortality, but modestly increases stent thrombosis. Discontinuation timing within 0 to 90 days was not statistically associated with treatment effects; however, this finding is hypothesis-generating given limited power across only three discontinuation nodes.
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Yusuf et al. (2026) conducted a meta-analysis in percutaneous coronary intervention. Early aspirin discontinuation with P2Y12 inhibitor monotherapy vs. Continued dual antiplatelet therapy (DAPT) was evaluated. Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without significant increases in MI, MACE, or mortality, but modestly increases stent thrombosis.
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