This meta-analysis compares early aspirin withdrawal (≤3 months) with continuing dual antiplatelet therapy (DAPT) versus monotherapy with ticagrelor or prasugrel in high-risk post-PCI patients. Seven randomized trials (n = 27,743) were included, with primary endpoints focusing on myocardial infarction (MI) and clinically relevant bleeding.
P2Y12-inhibitor monotherapy reduced bleeding relative to DAPT (hazard ratio 0.55; 95% CI 0.42–0.71). The effect on MI differed by timing of aspirin cessation: immediate aspirin noninitiation or in-hospital cessation increased MI risk (HR 1.41; 95% CI 1.01–1.97), whereas early post-discharge discontinuation within 3 months did not (HR 0.97; 95% CI 0.76–1.24).
Trial sequential analysis suggested conclusive bleeding benefit and futility for an excess of MI with early withdrawal. Analyses restricted to ACS supported the overall findings.
Bayesian analyses indicated risk-stratified timing: in high bleeding risk, aspirin stopping within 1 month yielded a 100% posterior probability of bleeding benefit (NNT ≈ 12) with 70% probability of MI safety; in high ischemic risk, stopping at 3 months yielded 100% probability of bleeding benefit (NNT ≈ 57) and 86% MI safety.
PLOS Medicine published a clinical update in Research Highlights on 26 Mar 2026.
The item focuses on Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials.
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