Aspirin-free therapy did not reduce major bleeding compared with DAPT in patients with high bleeding risk, regardless of whether they presented with acute coronary syndrome (ACS) or not, according to findings from the STOPDAPT-3 trial. The trial results were published in Circulation: Cardiovascular Interventions. 

The study analyzed 3,258 patients with HBR, including 1,803 with ACS and 1,455 without ACS. At one month after PCI, rates of major bleeding were similar between aspirin-free prasugrel monotherapy and DAPT. However, in ACS patients, the aspirin-free strategy was linked to a numerically higher risk of cardiovascular events, including death, myocardial infarction (MI), stent thrombosis, and stroke (7.9% vs 5.8%). In particular, the risk of MI was significantly higher in ACS patients treated without aspirin (1.6% vs 0.3%).

However, non-ACS patients did not show an excess risk of ischemic events. Outcomes between the two treatment approaches were comparable.