{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:05:25Z","timestamp":1785171925380,"version":"3.55.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients at high ischemic or bleeding risk after percutaneous coronary intervention (PCI) require protection against thrombotic events with dual antiplatelet therapy (DAPT) while avoiding bleeding. Although guidelines recommend 12-month DAPT after acute coronary syndrome (ACS), recent trials have tested the safety of early aspirin withdrawal with potent P2Y12-inhibitor monotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We performed a meta-analysis of randomized trials (from inception through August 2025) comparing early aspirin withdrawal (\u22643 months) with transition to ticagrelor- or prasugrel-monotherapy versus continued DAPT. Co-primary outcomes were myocardial infarction (MI) and clinically relevant bleeding. Prespecified timing analyses stratified the comparison versus DAPT by aspirin timing: immediate (aspirin noninitiation or in-hospital cessation) and early (post-discharge discontinuation within 3 months). Bayesian models quantified risk-stratified probabilities of benefit and harm; trial sequential analysis (TSA) assessed conclusiveness of evidence. Seven trials (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927,743) were included. P2Y12-inhibitor monotherapy reduced bleeding (HR\u2009=\u20090.55, 95% CI [0.42, 0.71];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) without significantly increasing MI overall (HR\u2009=\u20091.11, 95% CI [0.91, 1.35];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31), death, stroke, or stent thrombosis. Immediate aspirin noninitiation\/cessation increased MI (HR\u2009=\u20091.41, 95% CI [1.01, 1.97];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), whereas early discontinuation did not (HR\u2009=\u20090.97, 95% CI [0.76, 1.24];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.82). TSA indicated conclusiveness for bleeding benefit and futility for an MI excess. Analyses restricted to ACS confirmed the overall results. Bayesian analyses corroborated these effects and identified risk-aligned timing: in high bleeding risk,\u2009\u22641-month aspirin discontinuation yielded a 100% posterior probability of bleeding benefit (NNT\u2009=\u200912) and 70% probability of MI-safety; in high ischemic risk, 3-month aspirin discontinuation yielded 100% probability of bleeding benefit (NNT\u2009=\u200957) and 86% probability of MI-safety. Limitations include aggregate data only and limited precision for the immediate aspirin withdrawal subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among high-risk post-PCI patients on ticagrelor\/prasugrel, discontinuing aspirin within 3 months reduces bleeding without an ischemic trade-off versus DAPT. Immediate aspirin noninitiation or cessation should be avoided; timing should be individualized to bleeding and ischemic risk. PROSPERO: CRD420251167706.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004995","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T17:27:57Z","timestamp":1774546077000},"page":"e1004995","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-4589","authenticated-orcid":true,"given":"Eliano P.","family":"Navarese","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gurbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udaya","family":"Tantry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Talanas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudyna","family":"Grzelakowska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Umi\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Hoon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Bliden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safi U.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Kubica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Henry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Farkouh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean J.","family":"Kereiakes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"pmed.1004995.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h1618","article-title":"Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials","volume":"350","author":"EP Navarese","year":"2015","journal-title":"BMJ"},{"issue":"38","key":"pmed.1004995.ref002","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"RA Byrne","year":"2023","journal-title":"Eur Heart J"},{"issue":"23","key":"pmed.1004995.ref003","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1001\/jama.2020.7580","article-title":"Effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and cardiovascular events in patients with acute coronary syndrome: the TICO randomized clinical trial","volume":"323","author":"B-K Kim","year":"2020","journal-title":"JAMA"},{"issue":"21","key":"pmed.1004995.ref004","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1056\/NEJMoa1908419","article-title":"Ticagrelor with or without aspirin in high-risk patients after PCI","volume":"381","author":"R Mehran","year":"2019","journal-title":"N Engl J Med"},{"issue":"10439","key":"pmed.1004995.ref005","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/S0140-6736(24)00473-2","article-title":"Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial","volume":"403","author":"Z Ge","year":"2024","journal-title":"Lancet"},{"issue":"8","key":"pmed.1004995.ref006","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1161\/CIRCULATIONAHA.123.066720","article-title":"An aspirin-free versus dual antiplatelet strategy for coronary stenting: STOPDAPT-3 randomized trial","volume":"149","author":"M Natsuaki","year":"2024","journal-title":"Circulation"},{"key":"pmed.1004995.ref007","unstructured":"Higgins JPT, Thomas J. 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