In the current era of
percutaneous coronary intervention (PCI), with the use of contemporary
drug-eluting stents, refined techniques, and adjunctive
pharmacotherapy, the role of
aspirin peri-PCI remains undisputable. Beyond the initial period, dual antiplatelet
therapy (
DAPT) consisting of
aspirin and a P2Y12 receptor inhibitor for 6 months in stable
coronary artery disease and 12 months in
acute coronary syndromes is the standard of care. However, concerns regarding
bleeding adverse events caused by
aspirin have led to shortened
DAPT duration or even omission of
aspirin.
Aspirin free-strategies have been increasingly encountered in several studies and showed a significant reduction in
bleeding events, without any sign of increased ischemic risk. Individualization of
DAPT duration particularly in high
bleeding risk patients appears therefore mandatory, making
aspirin not necessary in several cases. Moreover, recent randomized trials have shed light on how to treat PCI patients in the presence of concomitant
anticoagulant treatment with P2Y12 monotherapy and excluding
aspirin. These
aspirin-free strategies have been proved safer than the "older" standard triple antithrombotic treatment, without compromising safety. Ongoing studies may further dispel the myths and establish real facts regarding post-PCI-tailored treatment with or without
aspirin.