Stopping aspirin 1 month after coronary stenting very much reduces bleeding complications in heart assault patients

Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-menace heart patients and preserving them on ticagrelor alone safely improves outcomes and reduces main bleeding by bigger than half when when put next with patients taking aspirin and ticagrelor combined (customarily identified as twin antiplatelet remedy or DAPT), which is the current identical outdated of care.

These are the outcomes from the ULTIMATE-DAPT question offered for the duration of a gradual-breaking trial presentation on the American School of Cardiology Scientific Sessions on Sunday, April 7, and printed in The Lancet.

Here is the principle and entirely trial to check high-menace patients with latest or threatened heart assault (acute coronary artery syndromes, or ACS) taking ticagrelor with a placebo starting one month after PCI, and compare them with ACS patients taking ticagrelor with aspirin over the identical length. The indispensable findings would possibly perhaps additionally trade the current guidelines for identical outdated of care worldwide.

“Our question has demonstrated that withdrawing aspirin in patients with latest ACS one month after PCI is efficacious by cutting back main and minor bleeding by one 365 days by bigger than 50 percent. Furthermore, there was as soon as no amplify in detrimental ischemic events, meaning persevering with aspirin was as soon as inflicting ruin without offering any encourage,” says Gregg W. Stone, MD, the question co-chair of ULTIMATE-DAPT, who offered the trial results.

“It’s miles my belief that or not it is time to trade the guidelines and identical outdated clinical notice such that we not treat most ACS patients with twin antiplatelet remedy beyond one month after a a hit PCI route of. Treating these high-menace patients with a single potent platelet inhibitor such as ticagrelor will toughen prognosis,” provides Dr. Stone, who’s Director of Academic Affairs for the Mount Sinai Effectively being Machine and Professor of Medication (Cardiology), and Inhabitants Effectively being Science and Protection, on the Icahn School of Medication at Mount Sinai.

The question analyzed 3,400 patients with ACS at 58 facilities in four international locations between August 2019 and October 2022. The full patients had passed by PCI, a non-surgical route of by which interventional cardiologists expend a catheter to advise stents in the blocked coronary arteries to restore blood float. The patients had been acquire one month after PCI and had been on ticagrelor and aspirin. Researchers randomized the patients after one month, withdrawing aspirin in 1,700 patients and putting them on ticagrelor and a placebo, while leaving the more than a couple of 1,700 patients on ticagrelor and aspirin. All patients had been evaluated between 1 and 12 months after the route of.

Throughout the question length, 35 patients in the ticagrelor-placebo neighborhood had a first-rate or minor bleeding match, when put next with 78 patients in the ticagrelor-aspirin neighborhood, meaning that the incidence of total bleeding incidents was as soon as diminished by 55 percent by withdrawing aspirin. The question also analyzed main detrimental cardiac and cerebrovascular events in conjunction with loss of life, heart assault, stroke, bypass graft surgical operation, or repeat PCI. These events came about in 61 patients in the ticagrelor-placebo neighborhood when put next with 63 patients in the ticagrelor-aspirin neighborhood, and weren’t statistically indispensable—extra demonstrating that putting off aspirin did no ruin and improved outcomes.

“It was as soon as previously believed that discontinuing twin antiplatelet remedy inner one 365 days after PCI in patients with ACS would amplify the menace of heart assault and varied ischemic complications, but the current question reveals that will not be the case, with up to the moment drug-eluting stents now obsolete in all PCI procedures. Discontinuing aspirin in patients with a latest or threatened heart assault who’re acquire one month after PCI is acquire and, by reducing excessive bleeding, improves outcomes,” Dr. Stone provides. “This query extends the outcomes of prior work that showed identical results but without the usual of the usage of a placebo, which eliminates bias from the question.”