META-ANALYSIS
Early aspirin withdrawal with P2Y12 inhibitor monotherapy vs. standard dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for acute coronary syndromes: a meta-analysis of randomised controlled trials
1
Midlands Metropolitan University Hospital, Smethwick, United Kingdom
2
James Cook University Hospital, Middlesbrough, United Kingdom
3
Department of Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudia Arabia
4
The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, NHS England
5
Lancashire Teaching Hospitals NHS Foundation Trust, Elderly Medicine, Lancashire, United Kingdom
6
James Cook University Hospital, Acute Medicine, Middlesbrough, United Kingdom
7
Department of Cardiology, Sheikh Shakhbout Medical City, United Arab Emirates
8
Worcestershire Acute Hospital Trust, NHS England
9
St. James’s University Hospital, LTHT, Leeds, United Kingdom
10
Kettering General Hospital NHS Trust Cardiology, Northamptonshire, United Kingdom
11
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
Submission date: 2026-03-22
Final revision date: 2026-05-18
Acceptance date: 2026-05-18
Publication date: 2026-06-26
Corresponding author
Arch Med Sci Atheroscler Dis 2026;11(1):111-122
KEYWORDS
P2Y12 inhibitor monotherapydual antiplatelet therapyaspirin withdrawalpercutaneous coronary interventionacute coronary syndrome
TOPICS
ABSTRACT
Introduction:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard antiplatelet strategy following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Prolonged aspirin exposure, however, increases the risk of bleeding, prompting evaluation of early aspirin discontinuation.
Material and Methods:
We performed a systematic search of RCTs comparing abbreviated DAPT followed by P2Y12 inhibitor monotherapy with DAPT in this population. Six RCTs involving 18,794 patients were included.
Results:
This strategy showed no significant difference compared with DAPT in the risk of major adverse cardiac and cerebrovascular events, all-cause death, cardiovascular death, myocardial infarction, and stroke. It was associated with significantly lower risk of clinically relevant bleeding (RR = 0.48), major bleeding (RR = 0.44), and net adverse events (RR = 0.80). However, the risk of stent thrombosis was higher with this strategy (RR = 1.83).
Conclusions:
Abbreviated DAPT followed by P2Y12 monotherapy maintains efficacy and lowers bleeding, with increased stent thrombosis risk.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard antiplatelet strategy following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Prolonged aspirin exposure, however, increases the risk of bleeding, prompting evaluation of early aspirin discontinuation.
Material and Methods:
We performed a systematic search of RCTs comparing abbreviated DAPT followed by P2Y12 inhibitor monotherapy with DAPT in this population. Six RCTs involving 18,794 patients were included.
Results:
This strategy showed no significant difference compared with DAPT in the risk of major adverse cardiac and cerebrovascular events, all-cause death, cardiovascular death, myocardial infarction, and stroke. It was associated with significantly lower risk of clinically relevant bleeding (RR = 0.48), major bleeding (RR = 0.44), and net adverse events (RR = 0.80). However, the risk of stent thrombosis was higher with this strategy (RR = 1.83).
Conclusions:
Abbreviated DAPT followed by P2Y12 monotherapy maintains efficacy and lowers bleeding, with increased stent thrombosis risk.
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