Aspirin discontinuation 1 to 3 months after angioplasty with continued P2Y12 inhibitor therapy reduces the bleeding risk without an increase in thrombotic events. This is also the case for patients admitted with acute coronary syndrome.
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has been shown to reduce the risk of major events compared with aspirin alone after angioplasty or acute coronary syndrome. Its price? An increased risk of bleeding.
The safety of discontinuing aspirin in favor of P2Y12 inhibitor monotherapy (as opposed to the standard of care) remains controversial.
To gather supporting evidence, this meta-analysis of 5 randomized studies with follow-up periods from 12 to 15 months was conducted.
In all studies, aspirin was interrupted 1 to 3 months post-angioplasty with continued P2Y12 inhibitor monotherapy compared with traditional dual antiplatelet therapy.
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The study population included 32,145 patients who underwent an angioplasty—over half of them, 56.1%, had an acute coronary syndrome.
In the experimental arm, 16.5% of patients continued taking a clopidogrel monotherapy, while 83.5% received prasugrel or ticagrelor.
Discontinuation of aspirin therapy 1 to 3 months after angioplasty reduced the risk of major bleeding by 40% compared with standard dual antiplatelet therapy (1.97% vs. 3.13%; hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.45-0.79).
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This discontinuation did not increase the risk of thrombotic events (2.73% vs. 3.11%; HR: 0.88; 95% CI: 0.77-1.02).
Findings were consistent among patients who underwent angioplasty in a setting of acute coronary syndrome, reducing the risk of bleeding even more than in the general population (50%, comparatively). In this higher-risk population, there was no increase in the risk of thrombotic events.
Original Title: The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y12 Inhibitor in Patients After Percutaneous Coronary Intervention. A Systematic Review and Meta-Analysis.
Reference: Michelle L. O’Donoghue et al. Circulation. 2020;142:538–545. DOI: 10.1161/CIRCULATIONAHA.120.046251.
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