The dawn of aspirin free strategy after short term dual antiplatelet for percutaneous coronary intervention: meta-analysis of randomized controlled trials

Abstract

There is still a debate about the safety and efficacy of an aspirin free strategy after percutaneous coronary intervention (PCI). Hence, we performed a meta-analysis comparing aspirin free strategy to dual antiplatlets therapy (DAPT). Randomized trials (RCTs) comparing aspirin free strategy to DAPT in patients who received PCI were included. The primary outcome of interest was bleeding, defined per the Bleeding Academic Research Consortium (BARC). Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACE); defined as all-cause mortality, myocardial infarction or stroke, the individual component of MACE and stent thrombosis. A total of 4 RCTs with 29,089 patients were included. There was significant reduction in BARC 2,3 or 5 bleeding events in patients who were treated with aspirin free strategy versus DAPT (HR 0.61, 95% CI 0.39−, p = 0.03, I ² = 89%). Moreover, although there was a trend of reduced major bleeding (BARC 3 or 5) outcomes in the aspirin free strategy group compared to the DAPT group, this did not achieve statistical significance (HR 0.63, 95% CI 0.37–1.06, p = 0.08, I ² = 795). Additionally, there was no difference between the aspirin free strategy and DAPT in term of MACE (HR 0.92, 95% CI 0.82–1.03, p = 0.13, I ² = 0%), all-cause mortality (HR 0.89, 95% CI 0.77–1.04, p = 0.15, I ² = 0%), MI (HR 0.89, 95% CI 0.74–1.08, p = 0.24, I ² = 0%), stroke (HR 1.13, 95% CI 0.65–1.99, p = 0.66, I ² = 60%) or stent thrombosis (HR 0.1.01, 95% CI 0.83–1.22, p = 0.93, I ² = 0%). Aspirin free strategy is as effective as DAPT in reducing MACE with better safety profile in term of bleeding.