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Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials

Author

Listed:
  • Eliano P Navarese
  • Paul Gurbel
  • Udaya Tantry
  • Giuseppe Talanas
  • Klaudyna Grzelakowska
  • Julia Umińska
  • Young-Hoon Jeong
  • Kevin Bliden
  • Safi U Khan
  • Jacek Kubica
  • Timothy D Henry
  • Michael E Farkouh
  • Dean J Kereiakes

Abstract

Background: Patients at high ischemic or bleeding risk after percutaneous coronary intervention (PCI) require protection against thrombotic events with dual antiplatelet therapy (DAPT) while avoiding bleeding. Although guidelines recommend 12-month DAPT after acute coronary syndrome (ACS), recent trials have tested the safety of early aspirin withdrawal with potent P2Y12-inhibitor monotherapy. Methods and findings: We performed a meta-analysis of randomized trials (from inception through August 2025) comparing early aspirin withdrawal (≤3 months) with transition to ticagrelor- or prasugrel-monotherapy versus continued DAPT. Co-primary outcomes were myocardial infarction (MI) and clinically relevant bleeding. Prespecified timing analyses stratified the comparison versus DAPT by aspirin timing: immediate (aspirin noninitiation or in-hospital cessation) and early (post-discharge discontinuation within 3 months). Bayesian models quantified risk-stratified probabilities of benefit and harm; trial sequential analysis (TSA) assessed conclusiveness of evidence. Seven trials (n = 27,743) were included. P2Y12-inhibitor monotherapy reduced bleeding (HR = 0.55, 95% CI [0.42, 0.71]; p

Suggested Citation

  • Eliano P Navarese & Paul Gurbel & Udaya Tantry & Giuseppe Talanas & Klaudyna Grzelakowska & Julia Umińska & Young-Hoon Jeong & Kevin Bliden & Safi U Khan & Jacek Kubica & Timothy D Henry & Michael E F, 2026. "Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials," PLOS Medicine, Public Library of Science, vol. 23(3), pages 1-19, March.
    • Handle: RePEc:plo:pmed00:1004995
    DOI: 10.1371/journal.pmed.1004995
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