Early Aspirin Discontinuation Following Acute Coronary Syndrome or Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Main Authors: Paul Guedeney, Jules Mesnier, Sabato Sorrentino, Farouk Abcha, Michel Zeitouni, Benoit Lattuca, Johanne Silvain, Salvatore De Rosa, Ciro Indolfi, Jean-Philippe Collet, Mathieu Kerneis, Gilles Montalescot
• Format: Article
• Language: English
• Published: MDPI AG 2020-03-01
• Series: Journal of Clinical Medicine
• Subjects: aspirin; p2y₁₂ inhibitors; antiplatelet therapy; acute coronary syndrome; percutaneous coronary intervention
• Online Access: https://www.mdpi.com/2077-0383/9/3/680

The respective ischemic and bleeding risks of early aspirin discontinuation following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remain uncertain. We performed a prospero-registered review of randomized controlled trials (RCTs) comparing a P2Y₁₂ inhibitor-based single antiplatelet strategy following early aspirin discontinuation to a strategy of sustained dual antiplatelet therapy (DAPT) in ACS or PCI patients requiring, or not, anticoagulation for another indication (CRD42019139576). We estimated risk ratios (RR) and 95% confidence intervals (CI) using random effect models. We included nine RCTs comprising 40,621 patients. Compared to prolonged DAPT, major bleeding (2.2% vs. 2.8%; RR 0.68; 95% CI: 0.54 to 0.87; <i>p</i> = 0.002; I^&#178;: 63%), non-major bleeding (5.0 % vs. 6.1 %; RR: 0.66; 95% CI: 0.47 to 0.94; <i>p </i>= 0.02; I^&#178; : 87%) and all bleeding (7.4% vs. 9.9%; RR: 0.65; 95% CI: 0.53 to 0.79; <i>p</i> &lt; 0.0001; I^&#178;: 88%) were significantly reduced with early aspirin discontinuation without significant difference for all-cause death (<i>p</i> = 0.60), major adverse cardiac and cerebrovascular events (MACE) (<i>p</i> = 0.60), myocardial infarction (MI) (<i>p</i> = 0.77), definite stent thrombosis (ST) (<i>p</i> = 0.63), and any stroke (<i>p</i> = 0.59). In patients on DAPT after an ACS or a PCI, early aspirin discontinuation prevents bleeding events with no significant adverse effect on the ischemic risk or mortality.