Clinical Question: Is it appropriate to stop aspirin after completing one month of dual antiplatelet therapy in patients who have undergone revascularization after an acute myocardial infarction?
Background: The prevailing standard of care in patients with acute myocardial infarction is continuation of dual antiplatelet therapy for at least one year after revascularization. However, dual antiplatelet therapy carries substantial risk of bleeding complications. With the advent of newer-generation drug-eluting stents, which have significantly reduced the risk of stent thrombosis, this study investigates whether prolonged dual antiplatelet therapy is still necessary.
Study Design: Open-label, randomized, controlled trial
Setting: 40 sites across Europe
Synopsis: Patients were selected as low risk as defined by undergoing complete revascularization of all significant lesions without complications within seven days of myocardial infarction. Patients with either high risk of bleeding or high risk of ischemic event (i.e., complex percutaneous coronary intervention [PCI], chronic total occlusion, left main disease, etc.) were excluded.
One month after PCI, 961 patients were randomized to receive P2712 inhibitor monotherapy and 981 patients continued dual antiplatelet therapy. The primary outcome was a composite of death from any cause, stent thrombosis, stroke, or major bleeding. The primary outcome at 11 months after randomization was similar in the monotherapy group compared to the antiplatelet therapy group (difference, -0.09%; 95% CI, -1.39 to 1.20; P=0.02 for noninferiority). Clinically relevant bleeding at 11 months after randomization was significantly lower in the monotherapy group (hazard ratio, 0.46; 95% CI, 0.29 to 0.75; P=0.002). Of note, the incidence of adverse events was lower overall than anticipated in both groups, which may limit the clinical relevance of these findings. The incidence of in-stent thrombosis was particularly low and similar in both groups.
Bottom Line: Among low-risk patients with acute myocardial infarction, it is appropriate to consider discontinuing aspirin after completing one month of dual antiplatelet therapy and to continue P2Y12 inhibitor alone.
Citation: Tarantini G, et al. Early discontinuation of aspirin after PCI in low-risk acute myocardial infarction. N Engl J Med. 2025;393(21):2083-2094. doi:10.1056/NEJMoa2508808.
Dr. Ji
Dr. Ji is a hospitalist at UC San Diego Health and an assistant clinical professor of medicine at UC San Diego, both in San Diego.