Early aspirin discontinuation after coronary stenting cuts bleeding without adverse consequences

In patients undergoing percutaneous coronary intervention, discontinuing aspirin after stenting reduces bleeding without increasing mortality and ischaemic events, a study has shown.

The results were based on a meta-analysis of aggregate data from randomized clinical trials enrolling participants receiving a percutaneous coronary intervention with stenting and assigned to either early aspirin discontinuation or dual antiplatelet therapy (DAPT).

Seven trials involving a total of 36,206 participants allocated to either early aspirin discontinuation (experimental therapy, n=18,088) or DAPT (control therapy, n=18,118) were included.

Over a median follow‐up of 12 months, all‐cause death occurred with similar frequency in the experimental and control groups (2.5 percent vs 2.9 percent; hazard ratio [HR], 0.91, 95 percent confidence interval [CI], 0.75–1.11; p=0.37).

Likewise, there were no significant between-group differences in the following ischaemic outcomes: myocardial infarction (HR, 1.02, 95 percent CI, 0.85–1.22; p=0.81), stent thrombosis (HR, 1.02, 95 percent CI, 0.87–1.20; p=0.83), or stroke (HR, 1.01, 95 percent CI, 0.68–1.49; p=0.96).

However, aspirin discontinuation proved more favourable than DAPT in terms of the risk of major bleeding (HR, 0.58, 95 percent CI, 0.43–0.77; p<0.01).

The present data challenge the current practice of antithrombotic treatment in patients receiving coronary stenting. Nevertheless, additional trials are needed to assess the comparative safety and efficacy of a monotherapy with more potent antiplatelet drugs in this population.