The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains an active area of investigation, particularly with contemporary stent platforms and potent P2Y12 inhibitors. In a reconstructed individual patient data meta-analysis of randomized controlled trials presented at EuroPCR 2026, investigators evaluated whether early aspirin discontinuation followed by potent P2Y12 inhibitor monotherapy could reduce bleeding while preserving ischemic protection.
The analysis included randomized trials comparing standard 12-month DAPT with strategies involving aspirin discontinuation after 1 to 2 months followed by P2Y12 inhibitor monotherapy. Individual patient data were reconstructed from published Kaplan-Meier curves and analyzed using stratified Cox regression models.
A total of five randomized trials involving 12,598 patients were included, with 6,499 patients assigned to early aspirin discontinuation.
Findings
- Early aspirin discontinuation was associated with a 59% lower risk of major bleeding compared with standard 12-month DAPT (hazard ratio [HR] 0.41; 95% confidence interval [CI] 0.39-0.50; P <0.0001).
- Major adverse cardiac event rates were similar between treatment strategies (HR 1.06; 95% CI 0.83-1.33; P = 0.65).
- Net adverse clinical events were lower with early aspirin discontinuation (HR 0.74; 95% CI 0.62-0.88; P <0.001).
- Stratified analyses showed a 69% reduction in major bleeding (HR 0.31; 95% CI 0.18-0.52; P <0.01) and a 55% reduction in clinically relevant bleeding (HR 0.45; 95% CI 0.34-0.60; P <0.001).
- No significant differences were observed in all-cause mortality, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization.
Among selected patients with ACS undergoing PCI with contemporary stents, aspirin discontinuation after 1 to 2 months followed by potent P2Y12 inhibitor monotherapy reduced bleeding and net adverse clinical events without significant increases in ischemic outcomes.
