Key result
Early aspirin discontinuation cuts net adverse clinical events ~23% vs. 12-month DAPT, driven by less bleeding.
Why the study?
In patients undergoing PCI for ACS, the impact of early aspirin discontinuation compared with standard 12-month DAPT on clinical outcomes was uncertain.
Does early aspirin discontinuation with P2Y12 inhibitor monotherapy reduce adverse clinical events compared to standard 12-month DAPT in ACS patients treated with PCI?
Meta-Analysis (n=31,505)
Does early aspirin discontinuation with P2Y12 inhibitor monotherapy reduce adverse clinical events compared to standard 12-month DAPT in ACS patients treated with PCI?
Odds Ratio: 0.77 (95% CI 0.65–0.91)
p-value: p=0.002
In ACS patients treated with PCI, dropping aspirin early (1-3 months) and continuing P2Y12 monotherapy reduces net adverse clinical events and major bleeding without increasing the risk of ischemic events compared to standard 12-month DAPT.
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), 12-month dual antiplatelet therapy (DAPT) has long been the standard of care. However, emerging evidence suggests that discontinuing aspirin early while maintaining P2Y12 inhibitor monotherapy may reduce bleeding without compromising ischemic protection. We performed a systematic review and meta-analysis to evaluate the impact of early aspirin discontinuation compared with standard 12-month DAPT on clinical outcomes after PCI for ACS. METHODS A meta-analysis was performed including randomized clinical trials and post-hoc analyses of randomized trials comparing early aspirin discontinuation (within 1-3 months post-PCI) to standard 12-month DAPT in ACS populations. The major endpoints were a composite of net adverse clinical events (NACE), major adverse cardiovascular events (MACE), all cause and cardiovascular mortality, MI, stroke, stent thrombosis (ST), target vessel revascularization (TVR), and bleeding. A random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. RESULTS Nine studies were included, encompassing 31,505 patients (15,700 early discontinuation; 15,805 standard DAPT). Across the 9 included studies, early aspirin discontinuation was associated with a significant reduction in NACE compared with standard DAPT (OR 0.77, 95% CI 0.65-0.91; p = 0.002) due to reduction in BARC ≥2 bleeding [0.41; 0.32-0.52; P <0.00001]. Early aspirin discontinuation, compared to 12-month DAPT resulted in similar risk of MACE [0.88; 0.73-1.07; P =0.19], all-cause mortality [0.84; 0.69-1.03; P= 0.09], cardiovascular mortality [1.02; 0.74-1.41; P = 0.92], MI [0.98; 0.77-1.25; P=0.87], stroke [0.97; 0.73-1.29; P =0.82], ST [1.29; 0.83-2.0; P=0.26] and TVR [1.00; 0.79-1.27; P = 1.00]. CONCLUSION In ACS patients treated with PCI, early discontinuation of aspirin while maintaining P2Y12 inhibitor monotherapy appears to reduce adverse clinical events compared with standard 12-month DAPT. These findings show net benefit of following early aspirin discontinuation strategy due to reduction in major bleeding events without jeopardizing ischemic outcomes.
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Kolupoti et al. (2026) conducted a meta-analysis in Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI) (n=31,505). Early aspirin discontinuation (within 1-3 months post-PCI) vs. Standard 12-month dual antiplatelet therapy (DAPT) was evaluated on Net adverse clinical events (NACE) (OR 0.77, 95% CI 0.65-0.91, p=0.002). Early aspirin discontinuation significantly reduced net adverse clinical events compared with standard 12-month DAPT (OR 0.77; 95% CI 0.65-0.91; p=0.002) driven by reduced bleeding.
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