TOPLINE:

In patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), stopping aspirin very early in favor of prasugrel or ticagrelor monotherapy was linked to a higher ischemic risk in the first month than standard dual antiplatelet therapy (DAPT), but ischemic outcomes were similar after 30 days, with fewer bleeding events on monotherapy.

METHODOLOGY:

• Researchers conducted a secondary analysis of the NEO-MINDSET trial to compare the effects of early withdrawal of aspirin in favor of potent P2Y12 inhibitor monotherapy with those of standard DAPT in adults with acute coronary syndrome after PCI with drug-eluting stents.
• Within 4 days of admission to hospital, 3410 patients were randomly assigned to receive either monotherapy with a potent P2Y12 inhibitor (prasugrel or ticagrelor) or standard DAPT including aspirin plus either of the same P2Y12 inhibitors for 12 months. In the monotherapy group, aspirin was discontinued immediately after randomization.
• The coprimary outcomes were a composite ischemic outcome of all-cause death, myocardial infarction, stroke, or urgent target-vessel revascularization and a bleeding outcome involving major or clinically relevant nonmajor bleeding.
• Researchers examined outcomes at 0-30 days and 31-365 days after randomization.
• The mean age of the patients was 59.6 years, and 29.3% were female.

TAKEAWAY:

• From 0 to 30 days, the composite ischemic outcome occurred in more patients receiving monotherapy than in those receiving DAPT (3.3% vs 1.8%; absolute risk difference, 1.5%; P = .006).
• Over the same period, bleeding events occurred in fewer patients receiving monotherapy than in those receiving DAPT (0.6% vs 1.5%; absolute risk difference, -0.8%; P = .018).
• From 31 to 365 days, the rate of ischemic events was 3.8% in both groups with no statistically significant difference in risk (P = .977). The rate of bleeding events remained lower with monotherapy than with DAPT (1.3% vs 3.5%; absolute risk difference, -2.2%; P < .001).
• From 31 to 365 days, the occurrence of net adverse clinical events was lower with monotherapy than with DAPT (4.9% vs 7.0%; P = .011).

IN PRACTICE:

“These data support current American College of Cardiology/American Heart Association guidelines recommending class I maintenance of DAPT during the first month post-ACS [acute coronary syndrome],” the researchers of the study wrote.

“Given the excess ischemic risk observed with monotherapy during the early post-procedural period, these findings do not support very early aspirin discontinuation following PCI,” they added.

SOURCE:

The study was led by Caio A.M. Tavares, MD, PhD, Hospital Israelita Albert Einstein, São Paulo, Brazil. It was published online on December 19, 2025, in the European Heart Journal.

LIMITATIONS:

Randomization within 4 days and strict exclusion criteria may have produced a cohort with lower risk, thus limiting generalizability. The open-label design may have introduced reporting bias. This secondary analysis was conducted without adjusting for multiple comparisons.

DISCLOSURES:

Funding sources or conflicts of interest were not specified for this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.