Dropping Aspirin and continuing with P2Y12 inhibitors safe 1 month after PCI: Study
Boston, MA: Aspirin discontinuation 1-3 months after PCI and continuing with P2Y12 inhibitor monotherapy reduces bleeding risk, according to a recent study in the journal Circulation. The study further found that aspirin discontinuation was not associated with an increased risk of MACE.
P2Y12 receptor blockers are another group of antiplatelet drugs that include: clopidogrel, ticlopidine, ticagrelor, prasugrel, and cangrelor.
Compared to aspirin alone, dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is known to reduce MACE risk after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS). However, there is a dispute on whether discontinuing aspirin in favor of P2Y12 inhibitor monotherapy is safe or not.
Michelle L. O'Donoghue, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, and colleagues conducted a meta-analysis from randomized trials (2001-2020) that studied aspirin discontinuation after 1-3 months of PCI with continued P2Y12 inhibitor monotherapy compared to traditional DAPT. Five trials were included; follow-up duration ranged from 12-15 months post PCI. The primary bleeding and MACE outcomes were the prespecified definitions in each trial.
The study population included 32,145 patients; 14,095 (43.8%) with stable CAD and 18,046 (56.1%) with ACS.
Key findings of the study include:
- In the experimental arm, background use of a P2Y12 inhibitor was clopidogrel in 2649 (16.5%) and prasugrel or ticagrelor in 13,408 (83.5%) of patients.
- In total, 820 patients experienced a primary bleeding outcome and 937 experienced MACE.
- Discontinuation of aspirin therapy 1-3 months post PCI significantly reduced the risk of major bleeding by 40% compared to DAPT (1.97% vs 3.13%), with no observed in the risk of MACE (2.73% vs 3.11%), MI (1.08% vs 1.27%) or death (1.25% vs 1.47%).
- Findings were consistent among patients who underwent PCI for an ACS, in whom discontinuation of aspirin after 1-3 months reduced bleeding by 50% (1.78% vs 3.58%) and did not appear to increase the risk of MACE (2.51% vs 2.98%).
"Discontinuation of aspirin with continued P2Y12 inhibitor monotherapy reduces the risk of bleeding when stopped 1-3 months after PCI. An increased risk of MACE was not observed following discontinuation of aspirin, including patients with ACS," concluded the authors.
The study, "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," is published in the journal Circulation.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.046251
