SYSTEMATIC REVIEW
Comparison of P2Y12 inhibitors vs. aspirin monotherapy following dual antiplatelet therapy in patients after percutaneous coronary intervention: a systematic review and meta-analysis
1
Acute Medicine, Sunderland Royal Hospital, Sunderland, UK
2
Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
3
Department of Cardiology, Aria institute of medical Sciences, Quetta, Pakistan
4
Saint Vincent Hospital, Worcester, Massachusetts, USA
5
University Hospitals Plymouth NHS Trust, Plymouth, UK
6
South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
7
University Hospital Birmingham NHS Foundation Trust. Birmingham, UK
8
Cardiology Department, Sheikh Shakhbout Medical City, UAE
9
Cardiothoracic Surgery and Transplant, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust, UK
10
Department of Internal Medicine, Specialty Hospital, Amman, Jordan
11
ST-4 Cardiology HEE-Wessex
12
Cardiology Department, Leeds Teaching Hospital Trust, UK
13
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
14
Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
15
Adjunct Clinical Lecturer, Newcastle University, UK
16
Sunderland University, Sunderland, UK
These authors had equal contribution to this work
Submission date: 2025-11-13
Final revision date: 2025-12-24
Acceptance date: 2026-01-02
Publication date: 2026-03-30
Arch Med Sci Atheroscler Dis 2026;11(1):24-37
KEYWORDS
TOPICS
ABSTRACT
Introduction:
P2Y12 inhibitor monotherapy has emerged as a potential alternative to aspirin following dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI), but the optimal choice remains uncertain.
Methods:
A systematic literature search compared P2Y12 inhibitors with aspirin post PCI. A random-effects model pooled odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes.
Results:
Seven studies (29,756 patients) were included. P2Y12 inhibitors significantly reduced MACE compared to aspirin [OR = 0.73; 95% CI: 0.64–0.84]. No significant difference was observed in all-cause mortality [OR = 0.90; 95% CI: 0.77–1.05], cardiac death [OR = 0.86; 95% CI: 0.68–1.09], major bleeding [OR = 1.06; 95% CI: 0.67–1.68], MI [OR = 0.78; 95% CI: 0.56–1.08], or stent thrombosis [OR = 0.71; 95% CI: 0.41–1.22]. P2Y12 inhibitors significantly reduced repeat revascularisation [OR = 0.83; 95% CI: 0.73–0.94] and stroke [OR = 0.63; 95% CI: 0.48–0.81].
Conclusions:
P2Y12 inhibitors may be a safer, more effective alternative to aspirin alone after PCI.
P2Y12 inhibitor monotherapy has emerged as a potential alternative to aspirin following dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI), but the optimal choice remains uncertain.
Methods:
A systematic literature search compared P2Y12 inhibitors with aspirin post PCI. A random-effects model pooled odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes.
Results:
Seven studies (29,756 patients) were included. P2Y12 inhibitors significantly reduced MACE compared to aspirin [OR = 0.73; 95% CI: 0.64–0.84]. No significant difference was observed in all-cause mortality [OR = 0.90; 95% CI: 0.77–1.05], cardiac death [OR = 0.86; 95% CI: 0.68–1.09], major bleeding [OR = 1.06; 95% CI: 0.67–1.68], MI [OR = 0.78; 95% CI: 0.56–1.08], or stent thrombosis [OR = 0.71; 95% CI: 0.41–1.22]. P2Y12 inhibitors significantly reduced repeat revascularisation [OR = 0.83; 95% CI: 0.73–0.94] and stroke [OR = 0.63; 95% CI: 0.48–0.81].
Conclusions:
P2Y12 inhibitors may be a safer, more effective alternative to aspirin alone after PCI.
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