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Omitting aspirin in PCI patients: Myth or reality?

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Abstract

In the current era of percutaneous coronary intervention (PCI), with the use of contemporary drug-eluting stents, refined techniques, and adjunctive pharmacotherapy, the role of aspirin peri-PCI remains undisputable. Beyond the initial period, dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor inhibitor for 6 months in stable coronary artery disease and 12 months in acute coronary syndromes is the standard of care. However, concerns regarding bleeding adverse events caused by aspirin have led to shortened DAPT duration or even omission of aspirin. Aspirin free-strategies have been increasingly encountered in several studies and showed a significant reduction in bleeding events, without any sign of increased ischemic risk. Individualization of DAPT duration particularly in high bleeding risk patients appears therefore mandatory, making aspirin not necessary in several cases. Moreover, recent randomized trials have shed light on how to treat PCI patients in the presence of concomitant anticoagulant treatment with P2Y12 monotherapy and excluding aspirin. These aspirin-free strategies have been proved safer than the “older” standard triple antithrombotic treatment, without compromising safety. Ongoing studies may further dispel the myths and establish real facts regarding post-PCI-tailored treatment with or without aspirin.

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Abbreviations

ACS:

acute coronary syndrome

CAD:

coronary artery disease

HBR:

high bleeding risk

NOAC:

non-vitamin K anticoagulant

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Authors and Affiliations

  1. 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 12462, Athens, Greece

    Dimitrios Alexopoulos & Aikaterini Mpahara

  2. 2nd Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    George Kassimis

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  1. Dimitrios Alexopoulos
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Correspondence to Dimitrios Alexopoulos.

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Dr. Alexopoulos discloses lecturing honoraria/advisory board fees from Astrazeneca, Bayer, Boehringer Ingelheim, Biotronik, Medtronic, Chiesi Hellas. Other authors have no disclosure.

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Alexopoulos, D., Mpahara, A. & Kassimis, G. Omitting aspirin in PCI patients: Myth or reality?. Cardiovasc Drugs Ther 33, 711–724 (2019). https://doi.org/10.1007/s10557-019-06916-7

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