Early Aspirin Withdrawal Versus Dual Antiplatelet Therapy After PCI: Meta‑analysis of Randomized

by 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 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.