05 September 2023

Patients who need anti-platelet therapy after being fitted with a coronary stent gain no benefit from not receiving aspirin, according to a study presented at a major cardiology conference.

Following percutaneous coronary intervention (PCI) with stent implantation, short durations of dual-anti-platelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy have been shown to reduce bleeding events without increasing cardiovascular events. However, the rate of major bleeding within the first month is still high.

So a research team, led by Dr Masahiro Natsuaki at Saga University, Japan, set out to discover whether monotherapy – without aspirin – might safely reduce these early bleeding events without risking cardiovascular events.

In the STOPDAPT-3 trial, monotherapy with the antiplatelet drug prasugrel was compared against dual-antiplatelet therapy (prasugrel and aspirin). Around 6,000 patients with high bleeding risk or acute coronary syndrome after being fitted with a drug-eluting stent participated in the study.

No significant benefit was seen in either group for bleeding or cardiovascular events, but the rate of cardiac procedures needed afterwards was higher in the group not given aspirin. Dual therapy including aspirin “should remain the standard strategy for PCI,” the researchers say.

Presenting the team’s work at the conference of the European Society of Cardiology held in Amsterdam, The Netherlands, Dr Natsuaki said: “The aspirin-free strategy compared with the dual strategy failed to reduce major bleeding within one month after PCI.

“Aspirin used for a limited period of one month after PCI as a component of dual therapy might have exerted a protective effect on vulnerable coronary lesions. It should remain the standard strategy for PCI even in the new-generation drug-eluting stent era.”

Source: European Society of Cardiology


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