Journal of the Society for Cardiovascular Angiography & Interventions · 2026
Early Aspirin Discontinuation Following PCI for Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Reconstructed Individual Patient Data.
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Oliveira Vinícius Martins Rodrigues, Barbosa Lucas M, Tartuce Ludimilla Pereira, Alcântara Robert Willian Anastácio, Tartuce Filho Paulo Roberto Ferreira, Nunes Maria do Carmo Pereira, Moreira Humberto Graner, Nascimento Bruno Ramos, Bhatt Deepak L
Аннотация
BACKGROUND: Dual antiplatelet therapy (DAPT) is well established for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Contemporary studies demonstrated that a shorter DAPT strategy may reduce bleeding, while preserving ischemic protection. However, optimal timing of aspirin discontinuation remains uncertain.
METHODS: We performed a systematic review and meta-analysis of randomized controlled trials comparing standard 12-month DAPT versus early aspirin discontinuation (≤1-2 months), following PCI for ACS, excluding studies with immediate aspirin withdrawal. We systematically searched PubMed, Embase, and Cochrane. Individual patient data were reconstructed from Kaplan-Meier (KM) curves. Hazard ratios (HRs) and their 95% CIs were estimated using Cox regression. All statistical analyses were performed using R software, version 4.5.0.
RESULTS: We included 5 randomized controlled trials comprising 12,984 patients; 6473 (49.8%) were randomized to early aspirin discontinuation. Short-term DAPT was associated with a reduction in the risk of bleeding (HR, 0.44; 95% CI, 0.34-0.55; P < .001), while preserving ischemic protection, with no differences in the risk of major adverse cardiac events (HR, 1.05; 95% CI, 0.83-1.32; P = .71). Stratified bleeding analyses demonstrated a reduction in major bleeding (HR, 0.40; 95% CI, 0.26-0.61; P < .01) and a reduction in clinically relevant bleeding (HR, 0.43; 95% CI, 0.34-0.55; P < .001).
CONCLUSION: In trials evaluating aspirin discontinuation at approximately 1 month following PCI for ACS, transitioning to P2Y12 inhibitor monotherapy reduced bleeding while preserving ischemic protection in selected patients.
METHODS: We performed a systematic review and meta-analysis of randomized controlled trials comparing standard 12-month DAPT versus early aspirin discontinuation (≤1-2 months), following PCI for ACS, excluding studies with immediate aspirin withdrawal. We systematically searched PubMed, Embase, and Cochrane. Individual patient data were reconstructed from Kaplan-Meier (KM) curves. Hazard ratios (HRs) and their 95% CIs were estimated using Cox regression. All statistical analyses were performed using R software, version 4.5.0.
RESULTS: We included 5 randomized controlled trials comprising 12,984 patients; 6473 (49.8%) were randomized to early aspirin discontinuation. Short-term DAPT was associated with a reduction in the risk of bleeding (HR, 0.44; 95% CI, 0.34-0.55; P < .001), while preserving ischemic protection, with no differences in the risk of major adverse cardiac events (HR, 1.05; 95% CI, 0.83-1.32; P = .71). Stratified bleeding analyses demonstrated a reduction in major bleeding (HR, 0.40; 95% CI, 0.26-0.61; P < .01) and a reduction in clinically relevant bleeding (HR, 0.43; 95% CI, 0.34-0.55; P < .001).
CONCLUSION: In trials evaluating aspirin discontinuation at approximately 1 month following PCI for ACS, transitioning to P2Y12 inhibitor monotherapy reduced bleeding while preserving ischemic protection in selected patients.