18 Oct 2019
Aspirin-free antiplatelet regimens after PCI: when is it best to stop aspirin and who could ultimately benefit?
EuroIntervention Journal
Over the past year, an abundance of clinical evidence has emerged addressing the conceptually appealing and theoretically justified concept of dropping aspirin, rather than the P2Y12 antagonist, as part of antiplatelet regimens after percutaneous coronary intervention (PCI).
In anticoagulated patients, a meta-analysis including 10,000 patients overall from WOEST, PIONEER-AF PCI, RE-DUAL PCI and AUGUSTUS indicated that omission of aspirin early after PCI allows reduction in bleeding with no significant trade-off regarding ischaemic protection3. After the publication of GLOBAL LEADERS in 2018, the year 2019 brought the results of STOPDAPT-2, SMART-CHOICE, and TWILIGHT (A Randomized Trial of Ticagrelor Monotherapy vs Ticagrelor Plus Aspirin Beginning at 3 Months in High-Risk Patients Undergoing PCI) presented by Roxana Mehran at Transcatheter Cardiovascular Therapeutics (TCT), San Francisco, USA, 2019, moving interventional cardiologists closer towards the answers to such practical questions as “When is it best to stop aspirin in patients without oral anticoagulant therapy?” and “Who could ultimately benefit from aspirin-free antiplatelet strategy after PCI?”.
Authors
M. Tomaniak, R. F. Storey, P. W. Serruys
