Ismaila Ajayi Yusuf, Olurotimi J Badero, Ihesiulo Alozie, Micah Okwah, Jeremiah Adepoju, Abieyuwa Oshodin, Ihesiulo Uzoma, Oluwashina Oyeleye, Emmanuella Asikong
Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without significant increases in MI, MACE, or mortality, but modestly increases stent thrombosis. Discontinuation timing within 0 to 90 days was not statistically associated with treatment effects; however, this finding is hypothesis-generating given limited power across only three discontinuation nodes.
BACKGROUND: Early aspirin discontinuation followed by P2Y12 inhibitor monotherapy is increasingly used after percutaneous coronary intervention (PCI), yet whether the timing of discontinuation within the early post-procedural period modifies clinical outcomes remains uncertain.
METHODS: We searched PubMed/MEDLINE, Scopus, Embase, CENTRAL, and ClinicalTrials.gov through March 5, 2026, for randomized controlled trials evaluating early aspirin discontinuation with P2Y12 inhibitor monotherapy versus continued dual antiplatelet therapy (DAPT) in adults undergoing PCI. Outcomes included major bleeding, stent thrombosis, myocardial infarction (MI), major adverse cardiovascular events (MACE), all-cause mortality, ischemic stroke, and net adverse clinical events (NACE).
RESULTS: Ten RCTs comprising 52,793 participants were included. Early aspirin discontinuation significantly reduced major bleeding (HR 0.59; 95% CI, 0.43-0.79; p = 0.0004), any bleeding (HR 0.52; 95% CI, 0.41-0.66; p < 0.0001), and NACE (HR 0.86; 95% CI, 0.76-0.97; p = 0.017), without significant increases in MI, MACE, or mortality. Stent thrombosis was significantly increased (HR 1.35; 95% CI, 1.03-1.78; p = 0.033; I2 = 0%), with a directional gradient from HR 1.62 at 0 days to HR 0.81 at 90 days. Meta-regression found no significant association between discontinuation timing and any outcome (all p > 0.05). Hartung-Knapp sensitivity analysis did not materially alter pooled estimates.
CONCLUSIONS: Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without significant increases in MI, MACE, or mortality, but modestly increases stent thrombosis. Discontinuation timing within 0 to 90 days was not statistically associated with treatment effects; however, this finding is hypothesis-generating given limited power across only three discontinuation nodes.