Early Aspirin Discontinuation After Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Hung Phan Huu, Phuong-Uyen Tran, Tian Zou et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis of randomized controlled trials assessed early aspirin discontinuation followed by P2Y12 inhibitor monotherapy versus standard dual antiplatelet therapy in patients with acute coronary syndrome undergoing PCI with drug-eluting stents. Seven trials involving 20,501 patients were included. Early discontinuation reduced bleeding (RR, 0.46; 95% CI, 0.36-0.60; p < 0.001), with no significant difference in major adverse cardiovascular events overall. However, stent thrombosis was more frequent with early discontinuation (RR, 1.72; 95% CI, 1.07-2.78).
Key findings
- Bleeding was lower with early aspirin discontinuation (RR, 0.46; 95% CI, 0.36-0.60; p < 0.001; I²=21.9%).
- Major adverse cardiovascular events did not differ significantly between strategies (RR, 0.98; 95% CI, 0.77-1.26).
- Early aspirin discontinuation was associated with increased stent thrombosis (RR, 1.72; 95% CI, 1.07-2.78).
- No significant differences were found in myocardial infarction, stroke, repeat revascularization, or all-cause mortality.
Why it matters
The findings highlight a trade-off relevant to antiplatelet decisions after PCI for acute coronary syndrome: less bleeding may come with greater stent-thrombosis risk, even when overall cardiovascular events do not differ significantly. Considering both bleeding and thrombotic risk is therefore important when interpreting evidence for aspirin withdrawal.
What to keep in mind
The authors note that further adequately powered studies are needed to assess rare ischemic outcomes, including stent thrombosis.