Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials

Eliano P Navarese, Paul Gurbel, Udaya Tantry, Giuseppe Talanas, Klaudyna Grzelakowska, Julia Umińska, Young-Hoon Jeong, Kevin Bliden, Safi U Khan, Jacek Kubica, Timothy D Henry, Michael E Farkouh and Dean J Kereiakes

PLOS Medicine, 2026, vol. 23, issue 3, 1-19

Abstract: Background: Patients at high ischemic or bleeding risk after percutaneous coronary intervention (PCI) require protection against thrombotic events with dual antiplatelet therapy (DAPT) while avoiding bleeding. Although guidelines recommend 12-month DAPT after acute coronary syndrome (ACS), recent trials have tested the safety of early aspirin withdrawal with potent P2Y12-inhibitor monotherapy. Methods and findings: We performed a meta-analysis of randomized trials (from inception through August 2025) comparing early aspirin withdrawal (≤3 months) with transition to ticagrelor- or prasugrel-monotherapy versus continued DAPT. Co-primary outcomes were myocardial infarction (MI) and clinically relevant bleeding. Prespecified timing analyses stratified the comparison versus DAPT by aspirin timing: immediate (aspirin noninitiation or in-hospital cessation) and early (post-discharge discontinuation within 3 months). Bayesian models quantified risk-stratified probabilities of benefit and harm; trial sequential analysis (TSA) assessed conclusiveness of evidence. Seven trials (n = 27,743) were included. P2Y12-inhibitor monotherapy reduced bleeding (HR = 0.55, 95% CI [0.42, 0.71]; p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1004995

DOI: 10.1371/journal.pmed.1004995

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