Study Finds Early Aspirin Stop Post‑PCI Risks Patients

New trial data suggest that early discontinuation of aspirin after percutaneous coronary intervention (PCI) may be safe for low‑risk patients who have suffered an acute myocardial infarction.

Study design and patient selection

The open‑label, randomized trial enrolled 1,942 participants across 40 European sites. Researchers chose patients who had complete revascularization of all significant lesions within seven days of their heart attack and who experienced no procedural complications. To focus on a low‑risk cohort, the protocol excluded individuals with high bleeding risk or complex coronary anatomy such as chronic total occlusions, left‑main disease, or other features that typically raise ischemic concerns.

One month after PCI, participants were allocated to either continue standard dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) or switch to monotherapy with the P2Y12 inhibitor alone. The two arms comprised 981 and 961 patients, respectively.

Outcomes at 11 months

The primary composite outcome—death from any cause, stent thrombosis, stroke, or major bleeding—was virtually identical between groups. The difference was –0.09% (95% CI, –1.39 to 1.20), meeting the predefined non‑inferiority criterion (P = 0.02). Clinically relevant bleeding, however, occurred less often in the monotherapy arm, with a hazard ratio of 0.46 (95% CI, 0.29 to 0.75; P = 0.002).

Overall event rates were lower than anticipated in both groups, limiting the broader applicability of the findings. In‑stent thrombosis was rare and showed no meaningful disparity between the two treatment strategies.

These results align with earlier observations that newer‑generation drug‑eluting stents reduce the risk of late thrombosis, potentially allowing clinicians to shorten the duration of aspirin exposure without compromising safety.

While the trial focused on patients without high bleeding or ischemic risk, the evidence could influence guideline discussions that currently recommend at least a year of dual antiplatelet therapy after myocardial infarction. The balance between preventing clotting events and avoiding bleeding complications remains a central consideration in post‑PCI management.

Bleeding risk dropped significantly.

One could argue that the study mirrors earlier efforts to streamline antiplatelet regimens in stable coronary disease, where shorter aspirin courses have already found acceptance. The present data extend that concept to an acute setting, albeit within a narrowly defined population.

Experts note that the trial’s open‑label nature and the relatively modest sample size warrant cautious interpretation. Real‑world patients often present with multiple comorbidities that were excluded from this investigation, which could affect both efficacy and safety outcomes.

In light of the findings, clinicians may consider stopping aspirin after one month of dual therapy in low‑risk acute myocardial infarction patients, provided that a potent P2Y12 inhibitor is maintained. Ongoing surveillance for bleeding and thrombotic events will be essential to confirm the durability of these early results.