Shorter aspirin, better outcomes? A new meta-analysis finds that stopping aspirin early during dual antiplatelet therapy (DAPT) after coronary stenting is linked to a 23% lower risk of net adverse clinical events compared to the standard 12-month regimen. Bleeding risk dropped significantly, and crucially, ischemic risks didn't go up. The findings suggest it may be time to rethink one-size-fits-all DAPT duration.
Shorter aspirin, better outcomes after coronary stenting
A large network meta-analysis published in Heart suggests that cutting aspirin short during dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) leads to meaningfully better outcomes than sticking with the standard 12-month DAPT regimen. The analysis pooled data from 11 randomized trials involving over 34,000 patients.
Strategies that dropped aspirin early — followed by P2Y12 inhibitor monotherapy — were tied to a 23% lower risk of net adverse clinical events (NACE), driven largely by significant reductions in bleeding. Importantly, no significant increase in heart attack, stroke, or other ischemic events was observed across the shorter strategies.
By the Numbers
Why it matters: These findings challenge the long-standing default of 12-month DAPT after ACS stenting. Researchers emphasize that DAPT duration should be individualized — patients at higher bleeding risk may benefit most from earlier aspirin discontinuation, while those with higher ischemic risk may still favor a 3-month strategy.
