TY - JOUR
T1 - Early aspirin discontinuation after coronary stenting
T2 - A systematic review and meta-analysis
AU - Wiebe, Jens
AU - Ndrepepa, Gjin
AU - Kufner, Sebastian
AU - Lahmann, Anna L.
AU - Xhepa, Erion
AU - Kuna, Constantin
AU - Voll, Felix
AU - Gosetti, Rosanna
AU - Laugwitz, Karl Ludwig
AU - Joner, Michael
AU - Kastrati, Adnan
AU - Cassese, Salvatore
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: The clinical impact of early aspirin discontinuation compared with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention with stenting remains poorly studied. We investigated the clinical outcomes of patients assigned to either early aspirin discontinuation or DAPT after percutaneous coronary intervention with stenting. METHODS AND RESULTS: We performed a meta-analysis of aggregate data from randomized clinical trials enrolling participants receiving a percutaneous coronary intervention with stenting and assigned to either early aspirin discontinuation or DAPT. Scientific databases were searched from inception through March 30, 2020. Trial-level hazard ratios (HRs) and 95% CIs were pooled using a random effects model with inverse variance weighting. The primary outcome was all-cause death. Secondary outcomes were myocardial infarction, stent thrombosis, stroke, and major bleeding. Overall, 36 206 participants were allocated to either early aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control therapy, n=18 118) in 7 trials. Median follow-up was 12 months. All-cause death occurred in 2.5% of patients assigned to experimental and 2.9% of patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI, 0.75-1.11; P=0.37). Overall, patients treated with experimental versus control therapy showed no significant difference in terms of myocardial infarction (HR, 1.02 [0.85-1.22], P=0.81), stent thrombosis (HR, 1.02 [0.87-1.20], P=0.83), or stroke (HR, 1.01 [0.68-1.49], P=0.96). However, the risk for major bleeding (HR, 0.58 [0.43-0.77], P<0.01) was significantly reduced by experimental as compared with control therapy. CONCLUSIONS: In patients treated with percutaneous coronary intervention and stenting, assigned to a strategy of early aspirin discontinuation versus DAPT, the risk of death and ischemic events is not significantly different but the risk of bleeding is lower.
AB - BACKGROUND: The clinical impact of early aspirin discontinuation compared with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention with stenting remains poorly studied. We investigated the clinical outcomes of patients assigned to either early aspirin discontinuation or DAPT after percutaneous coronary intervention with stenting. METHODS AND RESULTS: We performed a meta-analysis of aggregate data from randomized clinical trials enrolling participants receiving a percutaneous coronary intervention with stenting and assigned to either early aspirin discontinuation or DAPT. Scientific databases were searched from inception through March 30, 2020. Trial-level hazard ratios (HRs) and 95% CIs were pooled using a random effects model with inverse variance weighting. The primary outcome was all-cause death. Secondary outcomes were myocardial infarction, stent thrombosis, stroke, and major bleeding. Overall, 36 206 participants were allocated to either early aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control therapy, n=18 118) in 7 trials. Median follow-up was 12 months. All-cause death occurred in 2.5% of patients assigned to experimental and 2.9% of patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI, 0.75-1.11; P=0.37). Overall, patients treated with experimental versus control therapy showed no significant difference in terms of myocardial infarction (HR, 1.02 [0.85-1.22], P=0.81), stent thrombosis (HR, 1.02 [0.87-1.20], P=0.83), or stroke (HR, 1.01 [0.68-1.49], P=0.96). However, the risk for major bleeding (HR, 0.58 [0.43-0.77], P<0.01) was significantly reduced by experimental as compared with control therapy. CONCLUSIONS: In patients treated with percutaneous coronary intervention and stenting, assigned to a strategy of early aspirin discontinuation versus DAPT, the risk of death and ischemic events is not significantly different but the risk of bleeding is lower.
KW - Aspirin
KW - Coronary artery disease
KW - Meta-analysis
KW - Stent
UR - http://www.scopus.com/inward/record.url?scp=85100127283&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.018304
DO - 10.1161/JAHA.120.018304
M3 - Article
C2 - 33410332
AN - SCOPUS:85100127283
SN - 2047-9980
VL - 10
SP - 1
EP - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e018304
ER -