Aspirin use may be safely discontinued 1 month following percutaneous coronary intervention in patients with acute coronary syndromes, who can instead receive only ticagrelor instead of a combination of aspirin and ticagrelor.

Current guidelines suggest that following percutaneous coronary intervention, patients may reduce their risk of major adverse cardiovascular events such as heart attack or stroke by receiving aspirin and a P2Y12 inhibitor for 1 year; however, antiplatelet drugs may increase the risk of bleeding.

In the ULTIMATE-DAPT study, results of which were presented by Stone et al at the American College of Cardiology Annual Scientific Session 2024 and simultaneously published in The Lancet, researchers recruited 3,400 patients with acute coronary syndromes who underwent percutaneous coronary intervention and received dual antiplatelet therapy involving the use of aspirin plus the P2Y12 inhibitor ticagrelor for 1 month. The patients who experienced no adverse cardiovascular or bleeding events were then randomly assigned to receive either ticagrelor and placebo or continue dual antiplatelet therapy for an additional 11 months. The researchers found that 2.1% of patients in the ticagrelor and placebo group vs 4.6% of those in the dual antiplatelet therapy group had a clinically relevant bleeding rate; 3.6% vs 3.7% had a composite of major adverse cardiovascular events and cerebrovascular events at 12 months. The investigators deduced that patients who received ticagrelor monotherapy had a decreased risk of bleeding without an increased risk of ischemic thrombotic events.

Further studies exploring the efficacy of other P2Y12 inhibitors—such as prasugrel and clopidogrel—in this patient population may be necessary.

“[We] believe these results are … convincing and align with prior studies done without placebo. [H]opefully they will impact guidelines and lead to the routine use of only 1 month of [dual antiplatelet therapy] followed by a potent P2Y12 inhibitor … in most patients with [acute coronary syndromes] after successful [percutaneous coronary intervention],” concluded lead study author Gregg Stone, MD, Professor of Cardiology and Population Health Sciences at the Icahn School of Medicine at Mount Sinai.