Early aspirin discontinuation after coronary stenting: a systematic review and meta-analysis
Open accessAbstract
Background: The clinical impact of early aspirin discontinuation compared with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention with stenting remains poorly studied. We investigated the clinical outcomes of patients assigned to either early aspirin discontinuation or DAPT after percutaneous coronary intervention with stenting. Methods and Results: We performed 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 DAPT. Scientific databases were searched from inception through March 30, 2020. Trial‐level hazard ratios (HRs) and 95% CIs were pooled using a random effects model with inverse variance weighting. The primary outcome was all‐cause death. Secondary outcomes were myocardial infarction, stent thrombosis, stroke, and major bleeding. Overall, 36 206 participants were allocated to either early aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control therapy, n=18 118) in 7 trials. Median follow‐up was 12 months. All‐cause death occurred in 2.5% of patients assigned to experimental and 2.9% of patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI, 0.75–1.11; P =0.37). Overall, patients treated with experimental versus control therapy showed no significant difference in terms of myocardial infarction (HR, 1.02 [0.85–1.22], P =0.81), stent thrombosis (HR, 1.02 [0.87–1.20], P =0.83), or stroke (HR, 1.01 [0.68–1.49], P =0.96). However, the risk for major bleeding (HR, 0.58 [0.43–0.77], P <0.01) was significantly reduced by experimental as compared with control therapy. Conclusions: In patients treated with percutaneous coronary intervention and stenting, assigned to a strategy of early aspirin discontinuation versus DAPT, the risk of death and ischemic events is not significantly different but the risk of bleeding is lower.
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Early aspirin discontinuation compared with continued dual antiplatelet therapy after coronary stenting may reduce the risk of bleeding without a corresponding increase in the risks of mortality and ischemic events, as shown in a prespecified analysis of people with diabetes enrolled in the TWILIGHT trial and a meta-analysis.
“However, early aspirin discontinuation compared with continued dual antiplatelet therapy after coronary stenting may reduce the risk of bleeding without a corresponding increase in the risks of mortality and ischemic events, as shown in a prespecified analysis of people with diabetes enrolled in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [204]
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References 22 · Cited by 15
Research works printed but not linked: 18
- [1]Valgimigli M, Bueno H, Byrne RA, Collet J‐P, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J. 2018; 39: 213– 260. 28886622
- [2]Schömig A, Neumann F‐J, Kastrati A, Schühlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann‐Roth E‐M, Richardt G, Alt E, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary‐artery stents. N Engl J Med. 1996; 334: 1084– 1089. 8598866
- [3]Schömig A, Neumann F‐J, Walter H, Schühlen H, Hadamitzky M, Zitzmann‐Roth E‐M, Dirschinger J, Hausleiter J, Blasini R, Schmitt C, et al. Coronary stent placement in patients with acute myocardial infarction: comparison of clinical and angiographic outcome after randomization to antiplatelet or anticoagulant therapy. J Am Coll Cardiol. 1997; 29: 28– 34. 8996291
- [4]Vranckx P, Valgimigli M, Jüni P, Hamm C, Steg PG, Heg D, van Es GA, McFadden EP, Onuma Y, van Meijeren C, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug‐eluting stent: a multicentre, open‐label, randomised superiority trial. Lancet. 2018; 392: 940– 949. 30166073
- [5]Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, Cha JY, Collier T, Dangas G, Dudek D, et al. Ticagrelor with or without aspirin in high‐risk patients after PCI. N Engl J Med. 2019; 381: 2032– 2042. 31556978
- [7]Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016; 375: 2423– 2434. 27959713
- [8]Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, Maeng M, Merkely B, Zeymer U, Gropper S, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017; 377: 1513– 1524. 28844193
- [9]Vranckx P, Valgimigli M, Eckardt L, Tijssen J, Lewalter T, Gargiulo G, Batushkin V, Campo G, Lysak Z, Vakaliuk I, et al. Edoxaban‐based versus vitamin K antagonist‐based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST‐AF PCI): a randomised, open‐label, phase 3b trial. Lancet. 2019; 394: 1335– 1343. 31492505
- [10]Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. 22008217 PMC3196245
- [11]Juni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta‐analysis. JAMA. 1999; 282: 1054– 1060. 10493204
- [14]Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. Ann Intern Med. 2009; 151: 264– 269, W64. 19622511
- [16]Hahn J‐Y, Song YB, Oh J‐H, Chun WJ, Park YH, Jang WJ, Im E‐S, Jeong J‐O, Cho BR, Oh SK, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART‐CHOICE Randomized Clinical Trial. JAMA. 2019; 321: 2428– 2437. 31237645 PMC6593635
- [17]Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, Ohya M, Suwa S, Takagi K, Nanasato M, et al. Effect of 1‐month dual antiplatelet therapy followed by clopidogrel vs 12‐month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT‐2 Randomized Clinical Trial. JAMA. 2019; 321: 2414– 2427. 31237644 PMC6593641
- [19]Windecker S, Lopes RD, Massaro T, Jones‐Burton C, Granger CB, Aronson R, Heizer G, Goodman SG, Darius H, Jones WS, et al. Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome treated medically or with percutaneous coronary intervention or undergoing elective percutaneous coronary intervention: insights from the AUGUSTUS trial. Circulation. 2019; 140: 1921– 1932. 31557056
- [20]Capodanno D, Mehran R, Valgimigli M, Baber U, Windecker S, Vranckx P, Dangas G, Rollini F, Kimura T, Collet J‐P, et al. Aspirin‐free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol. 2018; 15: 480– 496. 29973709
- [21]Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta‐analysis. JAMA. 2019; 321: 277– 287. 30667501 PMC6439678
- [22]Khan SU, Singh M, Valavoor S, Khan MU, Lone AN, Khan MZ, Khan MS, Mani P, Kapadia SR, Michos ED, et al. Dual antiplatelet therapy after percutaneous coronary intervention and drug‐eluting stents: a systematic review and network meta‐analysis. Circulation. 2020; 142: 1425– 1436. 32795096 PMC7547897
- [23]Antithrombotic Trialists Collaboration. Collaborative meta‐analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002; 324: 71– 86. 11786451 PMC64503
- Authors
- Wiebe, J., Ndrepepa, G., Kufner, S., Lahmann, A. L., Xhepa, E., Kuna, C., Voll, F., Gosetti, R., Laugwitz, K., Joner, M., Kastrati, A., & Cassese, S.
- Affiliations
- Deutsches Herzzentrum München (DE)
- TUM Klinikum (DE)
- German Centre for Cardiovascular Research (DE)
- Corresponding author
- Cassese, Salvatore
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2021-01-19
- Volume
- 10
- Issue
- 2
- Pages
- e018304-e018304
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7955304
- OpenAlex
- W3119504588
- Cited by
- 15
- References
- 22
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 3
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- aspirin discontinuation, dual antiplatelet therapy, coronary stenting, percutaneous coronary intervention, stent thrombosis, major bleeding, all-cause mortality, myocardial infarction, stroke, antiplatelet therapy
- MeSH terms
- Dual Anti-Platelet Therapy, Duration of Therapy, Aspirin, Hemorrhage, Humans, Stents, Risk Assessment, Coronary Restenosis, Withholding Treatment, Percutaneous Coronary Intervention
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