Meta-analysis: Aspirin discontinuation safe soon after PCI
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Dropping aspirin and continuing with P2Y12 inhibitor monotherapy 1 to 3 months after PCI was safe, according to a new meta-analysis.
The researchers conducted a meta-analysis of five randomized trials with 32,145 patients (56.1% with ACS, the rest with stable CAD) who after PCI were administered dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor: clopidogrel, ticagrelor (Brilinta, AstraZeneca) or prasugrel (Effient, Daiichi Sankyo/Eli Lilly).
In the trials, follow-up ranged from 12 to 15 months after PCI and patients were assigned to remain on DAPT during all of follow-up or switch from DAPT to P2Y12 inhibitor monotherapy at 1 to 3 months.
Patients who were switched to P2Y12 inhibitor monotherapy had a 40% reduction in major bleeding risk compared with patients who remained on DAPT (1.97% vs. 3.13%; HR = 0.6; 95% CI, 0.45-0.79), Michelle L. O’Donoghue, MD, MPH, cardiovascular medicine specialist at Brigham and Women’s Hospital, senior investigator at the TIMI Study Group and associate professor of medicine at Harvard Medical School, and colleagues wrote.
There was no difference between the groups in a trial’s primary MACE outcome (monotherapy, 2.73%; DAPT, 3.11%; HR = 0.88, 95% CI, 0.77-1.02), MI (monotherapy, 1.08%; DAPT, 1.27%; HR = 0.85; 95% CI, 0.69-1.06), stent thrombosis (HR = 1.17; 95% CI 0.84-1.63) or death (monotherapy, 1.25%; DAPT, 1.47%; HR = 0.85; 95% CI, 0.7-1.03), according to the researchers.
Among those who had PCI for ACS, switching to monotherapy reduced major bleeding risk by 50% (1.78% vs. 3.58%; HR = 0.5; 95% CI, 0.41-0.61) without increasing MACE risk (monotherapy, 2.51%; DAPT, 2.98%; HR = 0.85, 0.7-1.03), the researchers wrote.
“The current findings ... provide some degree of reassurance that aspirin can be safely
discontinued 1 to 3 months after PCI in patients who continue monotherapy with a P2Y12 inhibitor and who are similar in terms of eligibility to the patients enrolled across the included studies,” O’Donoghue and colleagues wrote.
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