Aspirin-free strategies after percutaneous coronary intervention: Old habits, consolidated evidence and future perspectives.

Abstract

For almost two decades, dual antiplatelet therapy (DAPT) has been considered the cornerstone of pharmacological treatment in patients undergoing percutaneous coronary intervention (PCI). DAPT composition and duration have considerably evolved in the last decade moving from fixed treatment durations to tailored strategies based on the individual ischemic and bleeding risks. The increasing awareness of the prognostic relevance of bleeding events after PCI and the need for tailoring DAPT according to the individual bleeding and ischemic risks paved the way to newer DAPT modulation strategies by early aspirin withdrawal which have been shown to decrease bleeding without affecting therapeutic efficacy. There is mounting evidence suggesting that P2Y₁₂ inhibitor monotherapy is associated with lower risks of adverse ischemic events without bleeding risk trade-off in patients with a history of myocardial infarction or PCI compared with aspirin. These findings suggest that aspirin-free strategies at short and long-term after PCI might be associated with net benefit in presence of potent P2Y₁₂ receptor inhibition. In this Viewpoint, we provide a contemporary overview of available evidence on aspirin-free strategies, moving from the latest guidelines recommendations to future perspectives on modulation of antiplatelet therapy after PCI.