Why DAPT with aspirin after PCI is still a good idea
Immediate aspirin discontinuation after percutaneous coronary intervention (PCI) increases the risk of ischemic events and fails to reduce the risk of early bleeding, according to new data published in The American Journal of Cardiology.[1]
The study’s authors explored data from nearly 8,000 patients who originally participated in one of two studies, NEO-MINDSET or STOPDAPT-3. The mean age was 65 years old, and approximately 50% of patients immediately started P2Y12 inhibitor monotherapy after PCI instead of an initial period of dual antiplatelet therapy (DAPT) that combined a P2Y12 inhibitor and aspirin. P2Y12 inhibitors used in these studies were prasugrel and ticagrelor.
One of the study’s primary endpoints was ischemic events at 30 days. This was defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis or ischemic stroke for NEO-MINDSET patients and a composite of all-cause mortality, myocardial infarction, stroke or urgent-vessel revascularization for STOPDAPT-3 patients.
Overall, the ischemic event rate after 30 days was higher for patients who discontinued aspirin immediately after PCI. The absolute risk increase was 1.12%.
The study’s other primary endpoint was bleeding events at 30 days. The difference between the two patient groups was not significant, which was important given the fact that fewer bleeding events is a primary reason some clinicians have argued in favor of immediately discontinuing aspirin after PCI.
“Overall, these findings suggest that in acute coronary syndrome patients undergoing PCI, very early aspirin withdrawal does not reduce early bleeding and significantly increases ischemic events at 30 days,” wrote first author Vinícius Martins Rodrigues Oliveira, MS, a researcher with the Federal University of Goiás in Brazil, and colleagues. “In the contemporary PCI era, aspirin appears to remain essential in the first weeks after ACS, where the ischemic hazard remains clinically meaningful.”
Click here to read the team’s full analysis in The American Journal of Cardiology.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.