At the ESC 2025 Congress, researchers from Tianjin Medical University, China, presented real-world evidence that aspirin reloading before percutaneous coronary intervention (PCI) lowers early ischemic complications in patients already on chronic aspirin therapy—without adding bleeding risk.

While clopidogrel reloading is standard in acute coronary syndrome, the role of aspirin reloading has been less clear. This multicenter retrospective study analyzed 52,929 PCI patients across 82 hospitals (2010–2024). Among them, 8,823 received aspirin reloading (300 mg within 24h pre-PCI), while 44,106 continued maintenance dosing (100 mg).

After propensity score matching, 8,626 well-matched pairs were compared. Results showed:

• 1-month MACCE: 1.69% in reload group vs. 3.41% in maintenance (HR 0.51; p<0.001).
• Sustained reduction in MI: reload group consistently showed lower rates at 1, 3, and 6 months.
• Target vessel revascularization (TVR): sharply reduced at 1 month (0.50% vs. 2.46%; p<0.001).
• No excess bleeding risk: no differences in cardiac death, stroke, cerebral hemorrhage, or BARC type 2, 3, or 5 bleeding at any time point.

However, the protective effect on overall MACCE diminished beyond 3 months, suggesting the benefit is largely confined to the early post-PCI period.

The findings highlight the potential of reloading strategies to optimize peri-procedural antiplatelet therapy, particularly in the vulnerable first month after PCI.